{
  "Profile_Information": {
    "public_name": "Washington Medicaid",
    "state": "WASHINGTON",
    "formulary_name": "Washington Medicaid Formulary",
    "formulary_id": 17476,
    "formulary_version": 30,
    "formulary_effective_date": "08/01/2026"
  },
  "Drug_Information": [
    {
      "ndc": "08517355036",
      "ndc_label_name": "1st Tier Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517353036",
      "ndc_label_name": "1st Tier Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517354036",
      "ndc_label_name": "1st Tier Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517359536",
      "ndc_label_name": "1st Tier Unifine Pentips 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517385065",
      "ndc_label_name": "1st Tier Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517385036",
      "ndc_label_name": "1st Tier Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517383065",
      "ndc_label_name": "1st Tier Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517383036",
      "ndc_label_name": "1st Tier Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517384065",
      "ndc_label_name": "1st Tier Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517384036",
      "ndc_label_name": "1st Tier Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54288014410",
      "ndc_label_name": "Ablysinol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010502",
      "ndc_label_name": "Ablysinol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010515",
      "ndc_label_name": "Ablysinol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288014401",
      "ndc_label_name": "Ablysinol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68817013450",
      "ndc_label_name": "Abraxane Suspension Reconstituted 100 MG Intravenous",
      "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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069034405",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069246519",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069246510",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069246501",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65702072310",
      "ndc_label_name": "Accu-Chek Aviva Plus Kit w/Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65702040710",
      "ndc_label_name": "Accu-Chek Aviva Plus STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702040810",
      "ndc_label_name": "Accu-Chek Aviva Plus STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702010710",
      "ndc_label_name": "Accu-Chek Aviva SOLUTION IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65702048110",
      "ndc_label_name": "Accu-Chek FastClix Lancet KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702028810",
      "ndc_label_name": "Accu-Chek FastClix Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702071310",
      "ndc_label_name": "Accu-Chek Guide Control Liquid In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65702072910",
      "ndc_label_name": "Accu-Chek Guide KIT w/Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65702073110",
      "ndc_label_name": "Accu-Chek Guide Me Kit w/Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65702071910",
      "ndc_label_name": "Accu-Chek Guide Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702071210",
      "ndc_label_name": "Accu-Chek Guide Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702071110",
      "ndc_label_name": "Accu-Chek Guide Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702070195",
      "ndc_label_name": "Accu-Chek Guide Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924095120",
      "ndc_label_name": "Accu-Chek Safe-T Pro Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924007920",
      "ndc_label_name": "Accu-Chek Safe-T Pro Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702048810",
      "ndc_label_name": "Accu-Chek SmartView Control Liquid In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65702049210",
      "ndc_label_name": "Accu-Chek SmartView STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702049310",
      "ndc_label_name": "Accu-Chek SmartView STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702040010",
      "ndc_label_name": "Accu-Chek Softclix Lancet Dev KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702015610",
      "ndc_label_name": "Accu-Chek Softclix Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50924097110",
      "ndc_label_name": "Accu-Chek Softclix Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702012410",
      "ndc_label_name": "Accu-Chek Softclix Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702027510",
      "ndc_label_name": "Accutrend Glucose Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65702027410",
      "ndc_label_name": "Accutrend Glucose STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702045610",
      "ndc_label_name": "Accutrend Glucose STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49502020301",
      "ndc_label_name": "Ace Aerosol Cloud Enhancer",
      "drug_tier": "Non-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": false,
      "otc": false
    },
    {
      "ndc": "49281054758",
      "ndc_label_name": "ActHIB SOLUTION RECONSTITUTED Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51028000128",
      "ndc_label_name": "Acti-Lance 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638714120",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638731125",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638715510",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638732150",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489715510",
      "ndc_label_name": "Acti-Lance Lite Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638732350",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638714320",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489715710",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638731325",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638715710",
      "ndc_label_name": "Acti-Lance Special Lancets 17G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489715610",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638732250",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638731225",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638715610",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08638714220",
      "ndc_label_name": "Acti-Lance Universal 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61272000020",
      "ndc_label_name": "ActiMaris Wound Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50242008527",
      "ndc_label_name": "Activase SOLUTION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08439620301",
      "ndc_label_name": "Activity Pouch",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60007087777",
      "ndc_label_name": "Ad Post-Procedure Skin Barrier Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "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": false,
      "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": 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": false,
      "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": false,
      "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": false,
      "otc": false
    },
    {
      "ndc": "51144005001",
      "ndc_label_name": "Adcetris Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409193201",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714055601",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703877701",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409193202",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155025832",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714097201",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155025831",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478054430",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085730",
      "ndc_label_name": "Adenosine (Diagnostic) SOLUTION 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478054420",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019201",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703877601",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288020830",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019220",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019301",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714018001",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065130",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085820",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288020721",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714099701",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065120",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019330",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085930",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288020720",
      "ndc_label_name": "Adenosine (Diagnostic) Solution 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085620",
      "ndc_label_name": "Adenosine (Diagnostic) SOLUTION 3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065101",
      "ndc_label_name": "Adenosine Solution 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065190",
      "ndc_label_name": "Adenosine Solution 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021030168",
      "ndc_label_name": "Adenosine SOLUTION 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085404",
      "ndc_label_name": "Adenosine Solution 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021031804",
      "ndc_label_name": "Adenosine Solution 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065104",
      "ndc_label_name": "Adenosine SOLUTION 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065123",
      "ndc_label_name": "Adenosine Solution 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085400",
      "ndc_label_name": "Adenosine Solution 12 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021030167",
      "ndc_label_name": "Adenosine SOLUTION 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065189",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065100",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478054202",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085500",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021031802",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065121",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478054225",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085502",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065102",
      "ndc_label_name": "Adenosine SOLUTION 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518073501",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003302",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003300",
      "ndc_label_name": "Adenosine Solution 6 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08347200001",
      "ndc_label_name": "Adjustable Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "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": "42023016801",
      "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": "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": "42023016889",
      "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": "42023016899",
      "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": "42023072110",
      "ndc_label_name": "Adrenalin Solution 10-0.9 MG/250ML-% Intravenous",
      "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": "Non-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": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023043410",
      "ndc_label_name": "Adrenalin Solution 5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023043401",
      "ndc_label_name": "Adrenalin Solution 5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023050001",
      "ndc_label_name": "Adrenalin Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023050010",
      "ndc_label_name": "Adrenalin Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023031510",
      "ndc_label_name": "Adrenalin-NaCl Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023031501",
      "ndc_label_name": "Adrenalin-NaCl Solution 4-0.9 MG/250ML-% Intravenous",
      "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": "00143927701",
      "ndc_label_name": "Adriamycin Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83490044079",
      "ndc_label_name": "Adult Aerosol Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490044078",
      "ndc_label_name": "Adult Aerosol Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796009920",
      "ndc_label_name": "Adult Mask DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373081311",
      "ndc_label_name": "Adult Mask Large",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60010019572",
      "ndc_label_name": "Adv Diabetic Wound Hydrogel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317420005",
      "ndc_label_name": "Advance Intuition Control Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317420050",
      "ndc_label_name": "Advance Intuition Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317410602",
      "ndc_label_name": "Advance Micro-Draw Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317410501",
      "ndc_label_name": "Advance Micro-Draw Normal Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317415050",
      "ndc_label_name": "Advance Micro-Draw Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317410000",
      "ndc_label_name": "Advance Micro-Draw Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917018877",
      "ndc_label_name": "Advanced Mobile Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60010019574",
      "ndc_label_name": "Advanced MultiCare Hydrogel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784071342",
      "ndc_label_name": "Advantage Safety Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071343",
      "ndc_label_name": "Advantage Safety Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000138",
      "ndc_label_name": "Advocate Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000104",
      "ndc_label_name": "Advocate Control Solution Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000101",
      "ndc_label_name": "Advocate Control Solution Liquid Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52982000614",
      "ndc_label_name": "Advocate Insulin Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000152",
      "ndc_label_name": "Advocate Insulin Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000174",
      "ndc_label_name": "Advocate Insulin Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000173",
      "ndc_label_name": "Advocate Insulin Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000175",
      "ndc_label_name": "Advocate Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000176",
      "ndc_label_name": "Advocate Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000177",
      "ndc_label_name": "Advocate Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000164",
      "ndc_label_name": "Advocate Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000172",
      "ndc_label_name": "Advocate Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000170",
      "ndc_label_name": "Advocate Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000168",
      "ndc_label_name": "Advocate Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000109",
      "ndc_label_name": "Advocate Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000106",
      "ndc_label_name": "Advocate Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000110",
      "ndc_label_name": "Advocate Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52982000604",
      "ndc_label_name": "Advocate Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52982000600",
      "ndc_label_name": "Advocate Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000197",
      "ndc_label_name": "Advocate Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000103",
      "ndc_label_name": "Advocate Rapid-Safe Lancing",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000113",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000124",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000126",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000157",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000139",
      "ndc_label_name": "Advocate Redi-Code STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000160",
      "ndc_label_name": "Advocate Redi-Code+ Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000158",
      "ndc_label_name": "Advocate Redi-Code+ Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94046000187",
      "ndc_label_name": "Advocate Redi-Code+ Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000133",
      "ndc_label_name": "Advocate Redi-Code+ Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000118",
      "ndc_label_name": "Advocate Safety Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50033087945",
      "ndc_label_name": "Advocate Safety Lancets 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50033087946",
      "ndc_label_name": "Advocate Safety Lancets 23G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000192",
      "ndc_label_name": "Advocate Safety Lancets 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50033087947",
      "ndc_label_name": "Advocate Safety Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000100",
      "ndc_label_name": "Advocate Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351050512",
      "ndc_label_name": "Aerobika Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351062510",
      "ndc_label_name": "Aerobika DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351098550",
      "ndc_label_name": "AeroChamber Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351098810",
      "ndc_label_name": "AeroChamber Mini Chamber DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351098510",
      "ndc_label_name": "AeroChamber MV",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351050012",
      "ndc_label_name": "AeroChamber Pls FloVu Mthpiece Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456315467",
      "ndc_label_name": "AeroChamber Plus Flo-Vu",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090034800",
      "ndc_label_name": "AeroChamber Plus Flo-Vu",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351088910",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Interm Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351050412",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Interm Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351080810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456074613",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351050312",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351078810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Medium",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351050212",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Medium Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456074413",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351088810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351050112",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079850",
      "ndc_label_name": "AeroChamber Plus Flow VU",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079810",
      "ndc_label_name": "AeroChamber Plus Flow VU",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079710",
      "ndc_label_name": "AeroChamber Z-Stat Plus",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351079750",
      "ndc_label_name": "AeroChamber Z-Stat Plus Chambr",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351080710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Large",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351078710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Medium",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351088710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Small",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351050612",
      "ndc_label_name": "Aerochamber2GO Anti-Static Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351066510",
      "ndc_label_name": "AeroEclipse EZ Twist Tubing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351065850",
      "ndc_label_name": "AeroEclipse Mask Large",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351065950",
      "ndc_label_name": "AeroEclipse Mask Medium",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351065750",
      "ndc_label_name": "AeroEclipse Mask Small",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351052510",
      "ndc_label_name": "AeroTrach Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351085810",
      "ndc_label_name": "AeroVent Plus DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351085850",
      "ndc_label_name": "AeroVent Plus DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08554403601",
      "ndc_label_name": "AgaMatrix AMP Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554100320",
      "ndc_label_name": "AgaMatrix Control Level 2 Solution In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08554100340",
      "ndc_label_name": "AgaMatrix Control Level 4 Solution In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08554376402",
      "ndc_label_name": "AgaMatrix Control Normal/High Solution In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08554201101",
      "ndc_label_name": "AgaMatrix Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08554133301",
      "ndc_label_name": "AgaMatrix Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08554232001",
      "ndc_label_name": "AgaMatrix Jazz Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554318802",
      "ndc_label_name": "AgaMatrix Jazz Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554333702",
      "ndc_label_name": "AgaMatrix Presto Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554107410",
      "ndc_label_name": "AgaMatrix Presto Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554332901",
      "ndc_label_name": "AgaMatrix Presto Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554197101",
      "ndc_label_name": "AgaMatrix Ultra-Thin Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25208090104",
      "ndc_label_name": "Aggrastat Concentrate 3.75 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25208000104",
      "ndc_label_name": "Aggrastat CONCENTRATE 3.75 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25208000202",
      "ndc_label_name": "Aggrastat Solution 12.5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25208090202",
      "ndc_label_name": "Aggrastat Solution 12.5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25208000203",
      "ndc_label_name": "Aggrastat Solution 5-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25208090201",
      "ndc_label_name": "Aggrastat Solution 5-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25208000201",
      "ndc_label_name": "Aggrastat Solution 5-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51709000605",
      "ndc_label_name": "Aimsco Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134321001",
      "ndc_label_name": "Aimsco Twist Lancets 32G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134331001",
      "ndc_label_name": "Aimsco Twist Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796009921",
      "ndc_label_name": "AIRS Pediatric Aerosol Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462130045",
      "ndc_label_name": "Airzone Peak Flow Meter DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81298866003",
      "ndc_label_name": "AK-Fluor Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478025310",
      "ndc_label_name": "AK-Fluor Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754420004",
      "ndc_label_name": "Akovaz Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754420001",
      "ndc_label_name": "Akovaz Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754425001",
      "ndc_label_name": "Akovaz Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754425003",
      "ndc_label_name": "Akovaz Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079211",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079210",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079226",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632000",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079225",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079026",
      "ndc_label_name": "Albuked 5 Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079025",
      "ndc_label_name": "Albuked 5 Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982064301",
      "ndc_label_name": "Albumin Human Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982064302",
      "ndc_label_name": "Albumin Human Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982062301",
      "ndc_label_name": "Albumin Human Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982062302",
      "ndc_label_name": "Albumin Human Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982062303",
      "ndc_label_name": "Albumin Human Solution 5 % Intravenous",
      "drug_tier": "Non-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": "64208251203",
      "ndc_label_name": "Albuminex Solution 25 % 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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251204",
      "ndc_label_name": "Albuminex Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251207",
      "ndc_label_name": "Albuminex Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251002",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251001",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251005",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251006",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025190",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025105",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025110",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025191",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031025",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031090",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031050",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031091",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521600",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521604",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521609",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521601",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521607",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521603",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521605",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521606",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521608",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521602",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521902",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521400",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521404",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521402",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521403",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521407",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521804",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521401",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521406",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521405",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521409",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521408",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57513000645",
      "ndc_label_name": "Alcohol Pads PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000128",
      "ndc_label_name": "Alcohol Pads PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012112",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012114",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62850000001",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50002086054",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012120",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012117",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012118",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012119",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63517060001",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012113",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012111",
      "ndc_label_name": "Alcohol Prep Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777012116",
      "ndc_label_name": "Alcohol Prep PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014296",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536110301",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "82098081410",
      "ndc_label_name": "Alcohol Prep Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60006037780",
      "ndc_label_name": "Alcohol Prep Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60913000601",
      "ndc_label_name": "Alcohol Prep PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000787",
      "ndc_label_name": "Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011143",
      "ndc_label_name": "Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011133",
      "ndc_label_name": "Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011163",
      "ndc_label_name": "Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317628101",
      "ndc_label_name": "Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000011201",
      "ndc_label_name": "Alcohol Swabs PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917008216",
      "ndc_label_name": "Alcohol Swabs PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917012805",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917006104",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014455",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113200078",
      "ndc_label_name": "Alcohol Swabs Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090788400",
      "ndc_label_name": "Alcohol Swabs Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007088",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003175",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "19283059475",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017689503",
      "ndc_label_name": "Alcohol Swabs Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777030001",
      "ndc_label_name": "Alcohol Swabstick Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777030002",
      "ndc_label_name": "Alcohol Swabstick Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777030012",
      "ndc_label_name": "Alcohol Swabstick Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777030010",
      "ndc_label_name": "Alcohol Swabstick Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08462551000",
      "ndc_label_name": "All Flow 1000 PFT Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": "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": "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": "85006175401",
      "ndc_label_name": "Alymsys Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121175401",
      "ndc_label_name": "Alymsys Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121175407",
      "ndc_label_name": "Alymsys Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121175501",
      "ndc_label_name": "Alymsys Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85006175501",
      "ndc_label_name": "Alymsys Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121175507",
      "ndc_label_name": "Alymsys Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032101",
      "ndc_label_name": "Ambelvist Solution 0.2 MMOL/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032111",
      "ndc_label_name": "Ambelvist Solution 0.2 MMOL/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032211",
      "ndc_label_name": "Ambelvist Solution 0.75 MMOL/7.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032201",
      "ndc_label_name": "Ambelvist Solution 0.75 MMOL/7.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032311",
      "ndc_label_name": "Ambelvist Solution 1 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032301",
      "ndc_label_name": "Ambelvist Solution 1 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032411",
      "ndc_label_name": "Ambelvist Solution 1.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032401",
      "ndc_label_name": "Ambelvist Solution 1.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032801",
      "ndc_label_name": "Ambelvist Solution 3 MMOL/30ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032811",
      "ndc_label_name": "Ambelvist Solution 3 MMOL/30ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032601",
      "ndc_label_name": "Ambelvist Solution 3 MMOL/30ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032611",
      "ndc_label_name": "Ambelvist Solution 3 MMOL/30ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032911",
      "ndc_label_name": "Ambelvist Solution 6.5 MMOL/65ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032701",
      "ndc_label_name": "Ambelvist Solution 6.5 MMOL/65ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032901",
      "ndc_label_name": "Ambelvist Solution 6.5 MMOL/65ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032711",
      "ndc_label_name": "Ambelvist Solution 6.5 MMOL/65ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419033001",
      "ndc_label_name": "Ambelvist Solution Prefilled Syringe 0.75 MMOL/7.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419033011",
      "ndc_label_name": "Ambelvist Solution Prefilled Syringe 0.75 MMOL/7.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419033101",
      "ndc_label_name": "Ambelvist Solution Prefilled Syringe 1 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419033111",
      "ndc_label_name": "Ambelvist Solution Prefilled Syringe 1 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419033211",
      "ndc_label_name": "Ambelvist Solution Prefilled Syringe 1.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419033201",
      "ndc_label_name": "Ambelvist Solution Prefilled Syringe 1.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61470000005",
      "ndc_label_name": "Amerigel Wound Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61470101401",
      "ndc_label_name": "Amerigel Wound Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00409669511",
      "ndc_label_name": "Amidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409669502",
      "ndc_label_name": "Amidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409669512",
      "ndc_label_name": "Amidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409669501",
      "ndc_label_name": "Amidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990717217",
      "ndc_label_name": "Aminosyn II Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990717117",
      "ndc_label_name": "Aminosyn II Solution 15 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990417803",
      "ndc_label_name": "Aminosyn-PF 7% Solution 7 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990417905",
      "ndc_label_name": "Aminosyn-PF Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002120001",
      "ndc_label_name": "Amyvid SOLUTION 500-1900 MBQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572075010",
      "ndc_label_name": "Anectine Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572075001",
      "ndc_label_name": "Anectine Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781905395",
      "ndc_label_name": "Anectine Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341170",
      "ndc_label_name": "Anectine Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341195",
      "ndc_label_name": "Anectine Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81481080301",
      "ndc_label_name": "Anktiva Solution 400 MCG/0.4ML Intravesical",
      "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": "00008042301",
      "ndc_label_name": "Antivenin Micrurus Fulvius SOLUTION RECONSTITUTED Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00008042303",
      "ndc_label_name": "Antivenin Micrurus Fulvius SOLUTION RECONSTITUTED Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023010405",
      "ndc_label_name": "Aplisol SOLUTION 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023010401",
      "ndc_label_name": "Aplisol SOLUTION 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090133600",
      "ndc_label_name": "Aplisol Solution 5 UNIT/0.1ML Intradermal",
      "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": "Non-Preferred",
      "prior_authorization": true,
      "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": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089040",
      "ndc_label_name": "AQ Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089028",
      "ndc_label_name": "AQInject Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089025",
      "ndc_label_name": "AQInject Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60913000101",
      "ndc_label_name": "AquaLance Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58160084811",
      "ndc_label_name": "Arexvy Suspension Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043043",
      "ndc_label_name": "Argatroban in Sodium Chloride Solution 50-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043011",
      "ndc_label_name": "Argatroban in Sodium Chloride Solution 50-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150024101",
      "ndc_label_name": "Argatroban in Sodium Chloride Solution 50-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150024110",
      "ndc_label_name": "Argatroban in Sodium Chloride Solution 50-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409114001",
      "ndc_label_name": "Argatroban Solution 250 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023018289",
      "ndc_label_name": "Argatroban Solution 250 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928801",
      "ndc_label_name": "Argatroban Solution 250 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143967401",
      "ndc_label_name": "Argatroban SOLUTION 250 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457021202",
      "ndc_label_name": "Argatroban SOLUTION 250 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323052603",
      "ndc_label_name": "Argatroban Solution 250 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023018201",
      "ndc_label_name": "Argatroban SOLUTION 250 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143937701",
      "ndc_label_name": "Argatroban Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955901",
      "ndc_label_name": "Argatroban Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301006201",
      "ndc_label_name": "Argatroban Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145012601",
      "ndc_label_name": "Argatroban Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219042950",
      "ndc_label_name": "Argatroban Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021041450",
      "ndc_label_name": "Argatroban Solution 50 MG/50ML Intravenous",
      "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": "66758016594",
      "ndc_label_name": "Arranon Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078068361",
      "ndc_label_name": "Arranon Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021022610",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789060007",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918072002",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918072001",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789060010",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155086941",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099710",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155086931",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54879002710",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742043810",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121148301",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603033910",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323063710",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323063703",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021710",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000901",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099701",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121148307",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918072010",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710189501",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603033901",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000910",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710189506",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205017101",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205017107",
      "ndc_label_name": "Arsenic Trioxide Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349806",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121165806",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710189601",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150036610",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349895",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349894",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090001001",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150036601",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155087041",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205017201",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021022706",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121165801",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155087031",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710161001",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205017207",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710161006",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710189606",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090001010",
      "ndc_label_name": "Arsenic Trioxide Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73607001111",
      "ndc_label_name": "Artesunate Solution Reconstituted 110 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338964101",
      "ndc_label_name": "Artiss Kit 10 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338963701",
      "ndc_label_name": "Artiss Kit 2 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338963901",
      "ndc_label_name": "Artiss Kit 4 ML External",
      "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": false,
      "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": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72694051501",
      "ndc_label_name": "Asparlas Solution 3750 UNIT/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50486008410",
      "ndc_label_name": "Assess Peak Flow Meter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50486008415",
      "ndc_label_name": "Assess Peak Flow Meter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317550602",
      "ndc_label_name": "Assure 3 Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317555050",
      "ndc_label_name": "Assure 3 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317551000",
      "ndc_label_name": "Assure 3 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317560006",
      "ndc_label_name": "Assure 4 Control Level 1 & 2 Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317560100",
      "ndc_label_name": "Assure 4 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317560050",
      "ndc_label_name": "Assure 4 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60913000201",
      "ndc_label_name": "Assure Comfort Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317510006",
      "ndc_label_name": "Assure Control Solution 2/3 Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317500005",
      "ndc_label_name": "Assure Dose Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317500006",
      "ndc_label_name": "Assure Dose Norm/High Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317277531",
      "ndc_label_name": "Assure ID Duo Pro Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317276530",
      "ndc_label_name": "Assure ID Pro Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317220801",
      "ndc_label_name": "Assure II Check STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317220602",
      "ndc_label_name": "Assure II Control Level 1 & 2 Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317220501",
      "ndc_label_name": "Assure II Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317225050",
      "ndc_label_name": "Assure II STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317221000",
      "ndc_label_name": "Assure II STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980225",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980125",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980128",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980228",
      "ndc_label_name": "Assure Lance Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980121",
      "ndc_label_name": "Assure Lance Lancets 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990125",
      "ndc_label_name": "Assure Lance Plus Safety 25G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990130",
      "ndc_label_name": "Assure Lance Plus Safety 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317980328",
      "ndc_label_name": "Assure Lance Safety Lancet 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317502030",
      "ndc_label_name": "Assure Platinum Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317500050",
      "ndc_label_name": "Assure Platinum STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317500100",
      "ndc_label_name": "Assure Platinum STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317530006",
      "ndc_label_name": "Assure Prism Control Level 1&2 SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317532050",
      "ndc_label_name": "Assure Prism multi Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317530101",
      "ndc_label_name": "Assure Prism multi Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317530050",
      "ndc_label_name": "Assure Prism multi Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317460006",
      "ndc_label_name": "Assure Pro Control Level 1 & 2 Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317460100",
      "ndc_label_name": "Assure Pro Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317460050",
      "ndc_label_name": "Assure Pro Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "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": "00409110522",
      "ndc_label_name": "Atracurium Besylate Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409110502",
      "ndc_label_name": "Atracurium Besylate SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067210",
      "ndc_label_name": "Atracurium Besylate Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150021710",
      "ndc_label_name": "Atracurium Besylate SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288070210",
      "ndc_label_name": "Atracurium Besylate Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409110911",
      "ndc_label_name": "Atracurium Besylate Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409110901",
      "ndc_label_name": "Atracurium Besylate SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021065905",
      "ndc_label_name": "Atracurium Besylate Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150021605",
      "ndc_label_name": "Atracurium Besylate SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288070105",
      "ndc_label_name": "Atracurium Besylate Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23710006004",
      "ndc_label_name": "Atrapro Hydrogel GEL EXTERNAL",
      "drug_tier": "Non-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": "73317880101",
      "ndc_label_name": "AUM Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317678905",
      "ndc_label_name": "AUM Insulin Safety Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317628504",
      "ndc_label_name": "AUM Mini Insulin Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317628506",
      "ndc_label_name": "AUM Mini Insulin Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317628204",
      "ndc_label_name": "AUM Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317628206",
      "ndc_label_name": "AUM Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317624501",
      "ndc_label_name": "AUM ReadyGard Duo Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317778905",
      "ndc_label_name": "AUM Safety Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83226200101",
      "ndc_label_name": "Aurlumyn Solution 100 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50633034001",
      "ndc_label_name": "Aurlumyn Solution 100 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08214065724",
      "ndc_label_name": "Aurora Lancet Super Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214015724",
      "ndc_label_name": "Aurora Lancet Thin 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214030724",
      "ndc_label_name": "Aurora Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "25294000616",
      "ndc_label_name": "Auto-Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "25294000624",
      "ndc_label_name": "Auto-Lancet Mini",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214130001",
      "ndc_label_name": "Autoject 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470131001",
      "ndc_label_name": "Autoject 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214131001",
      "ndc_label_name": "Autoject 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470130001",
      "ndc_label_name": "Autoject 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214131101",
      "ndc_label_name": "Autoject 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470131101",
      "ndc_label_name": "Autoject 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214090001",
      "ndc_label_name": "Autolet II Clinisafe KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470090001",
      "ndc_label_name": "Autolet II Clinisafe KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027001",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027101",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214027001",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214027101",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68016016201",
      "ndc_label_name": "Autolet Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214057601",
      "ndc_label_name": "Autolet Lite Clinisafe KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470057601",
      "ndc_label_name": "Autolet Lite Clinisafe KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027901",
      "ndc_label_name": "Autolet Lite Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470056901",
      "ndc_label_name": "Autolet Lite Starter Pack KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214056901",
      "ndc_label_name": "Autolet Lite Starter Pack KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214026001",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214026501",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470026001",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470026501",
      "ndc_label_name": "Autolet Mini",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214030001",
      "ndc_label_name": "Autolet Platforms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214030201",
      "ndc_label_name": "Autolet Platforms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214030101",
      "ndc_label_name": "Autolet Platforms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470030001",
      "ndc_label_name": "Autolet Platforms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470030101",
      "ndc_label_name": "Autolet Platforms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470030201",
      "ndc_label_name": "Autolet Platforms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027401",
      "ndc_label_name": "Autolet Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214027501",
      "ndc_label_name": "Autolet Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470027601",
      "ndc_label_name": "Autolet Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50242006010",
      "ndc_label_name": "Avastin Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242006001",
      "ndc_label_name": "Avastin SOLUTION 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242006101",
      "ndc_label_name": "Avastin SOLUTION 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242006110",
      "ndc_label_name": "Avastin Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831012301",
      "ndc_label_name": "Avgemsi Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831012401",
      "ndc_label_name": "Avgemsi Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831013101",
      "ndc_label_name": "Axtle Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831013201",
      "ndc_label_name": "Axtle Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69932000101",
      "ndc_label_name": "Axumin Solution 9-221 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349194",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781325394",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714092701",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323077139",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150039301",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598014362",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057801",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143960601",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505627101",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598030562",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485020101",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052754",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001050454",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83774010201",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067811",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729030610",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457025430",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598046562",
      "ndc_label_name": "AzaCITIDine SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679009602",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069085701",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907022511",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011530",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001062054",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991079798",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121123701",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002001",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097080540",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288015395",
      "ndc_label_name": "AzaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679009601",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001031356",
      "ndc_label_name": "azaCITIDine Suspension Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087353501",
      "ndc_label_name": "Bavencio Solution 200 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290329515",
      "ndc_label_name": "BD AutoShield Duo 30G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328440",
      "ndc_label_name": "BD Ins Syr Ultrafine 1/2Unit 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290843803",
      "ndc_label_name": "BD Insulin Syr Ultrafine II 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290329485",
      "ndc_label_name": "BD Insulin Syringe 27.5G X 5/8\" 2 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324705",
      "ndc_label_name": "BD Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290309310",
      "ndc_label_name": "BD Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290324702",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290593201",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290324703",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090631200",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290305930",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090629700",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290593001",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290324704",
      "ndc_label_name": "BD Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290844001",
      "ndc_label_name": "BD Insulin Syringe Half-Unit 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290329412",
      "ndc_label_name": "BD Insulin Syringe MicroFine 27G X 5/8\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290841203",
      "ndc_label_name": "BD Insulin Syringe MicroFine 27G X 5/8\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290841201",
      "ndc_label_name": "BD Insulin Syringe MicroFine 27G X 5/8\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090627300",
      "ndc_label_name": "BD Insulin Syringe MicroFine 27G X 5/8\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290329465",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290329461",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290309305",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "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": "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": "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": "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": "08290309629",
      "ndc_label_name": "BD Insulin Syringe U-100 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290329654",
      "ndc_label_name": "BD Insulin Syringe U-100 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "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": true,
      "otc": false
    },
    {
      "ndc": "08290841103",
      "ndc_label_name": "BD Insulin Syringe U/F 30G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290329431",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 29G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290309301",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 29G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290309306",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 29G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290329466",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 29G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328431",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290843103",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290843101",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328280",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328279",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290846601",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290846603",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328466",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290841101",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328278",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328411",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 30G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328291",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290843801",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328438",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290846801",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328290",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328468",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328289",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290841801",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328418",
      "ndc_label_name": "BD Insulin Syringe Ultrafine 31G X 5/16\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290309637",
      "ndc_label_name": "BD Luer-Lok Syringe 20G X 1\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305780",
      "ndc_label_name": "BD Luer-Lok Syringe 25G X 5/8\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366594",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366592",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366593",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290320749",
      "ndc_label_name": "BD Pen Needle Micro Ultrafine 32G X 6 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090625200",
      "ndc_label_name": "BD Pen Needle Mini U/F 31G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320882",
      "ndc_label_name": "BD Pen Needle Mini Ultrafine 31G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320119",
      "ndc_label_name": "BD Pen Needle Mini Ultrafine 31G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320574",
      "ndc_label_name": "BD Pen Needle Nano 2nd Gen 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320550",
      "ndc_label_name": "BD Pen Needle Nano 2nd Gen 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320122",
      "ndc_label_name": "BD Pen Needle Nano Ultrafine 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320883",
      "ndc_label_name": "BD Pen Needle Nano Ultrafine 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320880",
      "ndc_label_name": "BD Pen Needle Orig Ultrafine 29G X 12.7MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290328203",
      "ndc_label_name": "BD Pen Needle Orig Ultrafine 29G X 12.7MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320881",
      "ndc_label_name": "BD Pen Needle Short Ultrafine 31G X 8 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290320109",
      "ndc_label_name": "BD Pen Needle Short Ultrafine 31G X 8 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290305935",
      "ndc_label_name": "BD SafetyGlide Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290305932",
      "ndc_label_name": "BD SafetyGlide Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290305934",
      "ndc_label_name": "BD SafetyGlide Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "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": "08290328447",
      "ndc_label_name": "BD SafetyGlide Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290328446",
      "ndc_label_name": "BD SafetyGlide Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290305937",
      "ndc_label_name": "BD SafetyGlide Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290326895",
      "ndc_label_name": "BD Swab Single Use Regular Pad",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290305903",
      "ndc_label_name": "BD Syringe/Needle 25G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324910",
      "ndc_label_name": "BD Veo Insulin Syr U/F 1/2Unit 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290491001",
      "ndc_label_name": "BD Veo Insulin Syr U/F 1/2Unit 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290490901",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290324906",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290324909",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290324911",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324907",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290491101",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324912",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290491201",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290324908",
      "ndc_label_name": "BD Veo Insulin Syr Ultrafine 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090625100",
      "ndc_label_name": "BD Veo Insulin Syringe U/F 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624900",
      "ndc_label_name": "BD Veo Insulin Syringe U/F 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090625000",
      "ndc_label_name": "BD Veo Insulin Syringe U/F 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710209201",
      "ndc_label_name": "Beizray Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710209208",
      "ndc_label_name": "Beizray Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710209304",
      "ndc_label_name": "Beizray Solution 2 x 80 MG/4ML & 25%(50 ML) Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710209103",
      "ndc_label_name": "Beizray Solution 80 MG/4ML & 25%(50 ML) Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72893000201",
      "ndc_label_name": "Beleodaq Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42367052125",
      "ndc_label_name": "Belrapzo Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622800",
      "ndc_label_name": "Bendamustine HCl Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019007901",
      "ndc_label_name": "Bendamustine HCl Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729025105",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001057241",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150039201",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505609600",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010320",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010210",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505609500",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150039101",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729025003",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001057141",
      "ndc_label_name": "Bendamustine HCl Solution Reconstituted 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459034804",
      "ndc_label_name": "Bendeka SOLUTION 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078082760",
      "ndc_label_name": "Beovu Solution Prefilled Syringe 6 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00008010001",
      "ndc_label_name": "Besponsa Solution Reconstituted 0.9 MG Intravenous",
      "drug_tier": "Non-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": true,
      "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": true,
      "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": true,
      "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": true,
      "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": 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": false,
      "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": 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": "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": "71863020205",
      "ndc_label_name": "Biorphen Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863020206",
      "ndc_label_name": "Biorphen Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017215",
      "ndc_label_name": "Biorphen Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017205",
      "ndc_label_name": "Biorphen Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017225",
      "ndc_label_name": "Biorphen Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59519000201",
      "ndc_label_name": "BioTel Care Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42023062210",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution 250 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023062201",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution 250 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027503",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781915895",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315894",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315895",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027567",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436002580",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409830015",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409830010",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323056201",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111065207",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457025600",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288042710",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323056210",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150021010",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781915894",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409830020",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323056215",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457025610",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436002582",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288042792",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572003501",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040210",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288042791",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409830025",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040241",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572003510",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634040010",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111065237",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323056241",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288042711",
      "ndc_label_name": "Bivalirudin Trifluoroacetate Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "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": 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": false,
      "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": false,
      "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": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71837100002",
      "ndc_label_name": "Bizengri (750 MG Dose) Solution Therapy Pack 375 MG/18.75ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71837100001",
      "ndc_label_name": "Bizengri (750 MG Dose) Solution Therapy Pack 375 MG/18.75ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173091301",
      "ndc_label_name": "Blenrep Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924001",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 15 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033218",
      "ndc_label_name": "Bleomycin Sulfate SOLUTION RECONSTITUTED 15 UNIT INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409033220",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 15 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703315401",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 15 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010610",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 15 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323013610",
      "ndc_label_name": "Bleomycin Sulfate SOLUTION RECONSTITUTED 15 UNIT INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714088601",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 15 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409032320",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 30 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703315501",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 30 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924101",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 30 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703032322",
      "ndc_label_name": "Bleomycin Sulfate SOLUTION RECONSTITUTED 30 UNIT INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010720",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 30 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090801",
      "ndc_label_name": "Bleomycin Sulfate Solution Reconstituted 30 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323013720",
      "ndc_label_name": "Bleomycin Sulfate SOLUTION RECONSTITUTED 30 UNIT INJECTION",
      "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": "55513016021",
      "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": "11917005075",
      "ndc_label_name": "Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036740",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036745",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012210",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917006463",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012211",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917005076",
      "ndc_label_name": "Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003182",
      "ndc_label_name": "Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036741",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036742",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295011717",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295011716",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012915",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800036744",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012916",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012208",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012917",
      "ndc_label_name": "Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539391502",
      "ndc_label_name": "Blood Glucose Test Strips 333 Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81284031500",
      "ndc_label_name": "Bludigo Solution 8 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81284031505",
      "ndc_label_name": "Bludigo Solution 8 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08496701701",
      "ndc_label_name": "BluLink Control High & Low Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496701501",
      "ndc_label_name": "BluLink Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "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": false,
      "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": false,
      "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": 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": false,
      "otc": false
    },
    {
      "ndc": "00409170401",
      "ndc_label_name": "Bortezomib Solution Reconstituted 1 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409170301",
      "ndc_label_name": "Bortezomib Solution Reconstituted 2.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021026210",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054036",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019099101",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030331",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409170001",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150033701",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143909801",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505605004",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000801",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742048401",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021024410",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082110",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001053436",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069083601",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598042660",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205018301",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027001",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710141101",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054136",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860022510",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634020810",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011810",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121248401",
      "ndc_label_name": "Boruzu Solution 3.5 MG/1.4ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023114501",
      "ndc_label_name": "Botox SOLUTION RECONSTITUTED 100 UNIT INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023114502",
      "ndc_label_name": "Botox Solution Reconstituted 100 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023392102",
      "ndc_label_name": "Botox SOLUTION RECONSTITUTED 200 UNIT INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73317495202",
      "ndc_label_name": "Breathe Comfort Chamber/Adult Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73317495201",
      "ndc_label_name": "Breathe Comfort Chamber/Child Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70914003330",
      "ndc_label_name": "Breathe Ease Large Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70914003320",
      "ndc_label_name": "Breathe Ease Medium Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70914003610",
      "ndc_label_name": "Breathe Ease Neb Mask/Child",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70914003600",
      "ndc_label_name": "Breathe Ease Neb Mask/Infant",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70914003620",
      "ndc_label_name": "Breathe Ease Neb Mask/Infant",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70914003700",
      "ndc_label_name": "Breathe Ease Peak Flow Meter Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70914003310",
      "ndc_label_name": "Breathe Ease Small Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462430200",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462430100",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462430120",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462430220",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42023010501",
      "ndc_label_name": "Brevital Sodium Solution Reconstituted 500 MG 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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065080050",
      "ndc_label_name": "BSS Plus Solution Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065079515",
      "ndc_label_name": "BSS Solution Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065179504",
      "ndc_label_name": "BSS Solution Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065079550",
      "ndc_label_name": "BSS Solution Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065179540",
      "ndc_label_name": "BSS Solution Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071805",
      "ndc_label_name": "BUPivacaine Fisiopharma Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923072010",
      "ndc_label_name": "BUPivacaine Fisiopharma Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071910",
      "ndc_label_name": "Bupivacaine Fisiopharma Solution 2.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071705",
      "ndc_label_name": "Bupivacaine Fisiopharma Solution 2.5 MG/ML Injection",
      "drug_tier": "Non-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": "Non-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": "Non-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": "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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266026310",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266026301",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266026410",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266026401",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71351002202",
      "ndc_label_name": "Bupivacaine in Dextrose Solution 0.75-8.25 % Intrathecal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71351002210",
      "ndc_label_name": "Bupivacaine in Dextrose Solution 0.75-8.25 % Intrathecal",
      "drug_tier": "Non-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": "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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904201",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904216",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.25% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904211",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.25% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904217",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904511",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904516",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904517",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904501",
      "ndc_label_name": "Bupivacaine-Epinephrine (PF) SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904301",
      "ndc_label_name": "Bupivacaine-Epinephrine SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904311",
      "ndc_label_name": "Bupivacaine-Epinephrine SOLUTION 0.25% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483003500",
      "ndc_label_name": "BUPivacaine-EPINEPHrine Solution 0.25% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483003600",
      "ndc_label_name": "BUPivacaine-EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904601",
      "ndc_label_name": "Bupivacaine-Epinephrine SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409904611",
      "ndc_label_name": "Bupivacaine-Epinephrine SOLUTION 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924601",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023017905",
      "ndc_label_name": "Buprenorphine HCl SOLUTION 0.3 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069002701",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924605",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069002705",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409201203",
      "ndc_label_name": "Buprenorphine HCl SOLUTION 0.3 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023017901",
      "ndc_label_name": "Buprenorphine HCl SOLUTION 0.3 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021024110",
      "ndc_label_name": "Busulfan SOLUTION 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409111201",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219016001",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505617700",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517092008",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409111210",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219016010",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517092001",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021001",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729035103",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457089308",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457089300",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011611",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729035192",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021008",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011610",
      "ndc_label_name": "Busulfan Solution 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148007090",
      "ndc_label_name": "Busulfex SOLUTION 6 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148007091",
      "ndc_label_name": "Busulfex SOLUTION 6 MG/ML Intravenous",
      "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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162301",
      "ndc_label_name": "Butorphanol Tartrate SOLUTION 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162621",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162642",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162602",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162601",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64406001901",
      "ndc_label_name": "Byooviz Solution 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64406001907",
      "ndc_label_name": "Byooviz Solution 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82667001805",
      "ndc_label_name": "Byooviz Solution 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040603",
      "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": "63323040601",
      "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": "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": "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": "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": "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": "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": "00517250201",
      "ndc_label_name": "Caffeine-Sodium Benzoate Solution 125-125 MG/ML Injection",
      "drug_tier": "Non-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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253090036",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163110",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374091310",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121109902",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069077301",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253090030",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409492811",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230804",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230801",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253090091",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517671010",
      "ndc_label_name": "Calcium Chloride SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121109955",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005201",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000500",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517671001",
      "ndc_label_name": "Calcium Chloride SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005210",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090236100",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409492834",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329330401",
      "ndc_label_name": "Calcium Chloride SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069077310",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230901",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230907",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090236200",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918425",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036061",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062301",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918025",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036019",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918001",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145017001",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036001",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090339800",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145017025",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072701",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918501",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036003",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062310",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072710",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145017220",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063019",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079025",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834017119",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918520",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078910",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063001",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834017101",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079101",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830167402",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072801",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264560052",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072820",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072725",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072810",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036005",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830167302",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830167202",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036059",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145017101",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145017125",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145017201",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078925",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079050",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079120",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236209",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062084",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062001",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062024",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062002",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219016201",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236201",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236202",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219016210",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.675 GM/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062201",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.8 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062224",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 1-0.8 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062101",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236309",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062124",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062184",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567062102",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236302",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219016401",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236301",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219016450",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.675 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66220028422",
      "ndc_label_name": "Caldolor Solution 800 MG/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66220028411",
      "ndc_label_name": "Caldolor Solution 800 MG/200ML Intravenous",
      "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": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009752903",
      "ndc_label_name": "Camptosar Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009011205",
      "ndc_label_name": "Camptosar Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009008202",
      "ndc_label_name": "Camptosar Solution 300 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009752905",
      "ndc_label_name": "Camptosar Solution 300 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009752910",
      "ndc_label_name": "Camptosar Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009752904",
      "ndc_label_name": "Camptosar Solution 40 MG/2ML Intravenous",
      "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": "16729029533",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424601",
      "ndc_label_name": "CARBOplatin SOLUTION 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033922",
      "ndc_label_name": "CARBOplatin SOLUTION 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628203",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288016501",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424681",
      "ndc_label_name": "CARBOplatin SOLUTION 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703015005",
      "ndc_label_name": "CARBOplatin Solution 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029534",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628206",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150033500",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424801",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703026205",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033950",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424881",
      "ndc_label_name": "CARBOplatin SOLUTION 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288016601",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742044745",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150033501",
      "ndc_label_name": "CARBOplatin Solution 450 MG/45ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029531",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288016401",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424401",
      "ndc_label_name": "CARBOplatin SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628201",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033918",
      "ndc_label_name": "CARBOplatin SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703424481",
      "ndc_label_name": "CARBOplatin SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703036018",
      "ndc_label_name": "CARBOplatin Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703423901",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703423981",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029512",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703060005",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703033956",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288016701",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742044860",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017260",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335028440",
      "ndc_label_name": "CARBOplatin SOLUTION 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628207",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150038600",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150038601",
      "ndc_label_name": "CARBOplatin Solution 600 MG/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598069811",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409006401",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598091711",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598091758",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143944201",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013201",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143944210",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021047701",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150045901",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598091958",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512085901",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512085905",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409006410",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121168001",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598091911",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057901",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332077701",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013210",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839013701",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81665020210",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598069858",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121168007",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150045910",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332077710",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298501003",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011201",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057900",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839013710",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81665020201",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298501005",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784024001",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298501001",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784024010",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011202",
      "ndc_label_name": "Carboprost Tromethamine Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017911",
      "ndc_label_name": "Carboprost Tromethamine Solution Prefilled Syringe 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017910",
      "ndc_label_name": "Carboprost Tromethamine Solution Prefilled Syringe 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08525010801",
      "ndc_label_name": "CardioCom Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11994000155",
      "ndc_label_name": "Cardiolite Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994000120",
      "ndc_label_name": "Cardiolite Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285011101",
      "ndc_label_name": "Cardioplegia Ind Plasma-Tromet Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285000201",
      "ndc_label_name": "Cardioplegia Induction High K Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285010201",
      "ndc_label_name": "Cardioplegia Induction High K Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72196011101",
      "ndc_label_name": "Cardioplegia Induction High K Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72196000201",
      "ndc_label_name": "Cardioplegia Induction High K Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285010601",
      "ndc_label_name": "Cardioplegia Induction High K Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285010401",
      "ndc_label_name": "Cardioplegia Main Low Trometha Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72196011201",
      "ndc_label_name": "Cardioplegia Main Plasma-Trome Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285011201",
      "ndc_label_name": "Cardioplegia Main Plasma-Trome Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285010301",
      "ndc_label_name": "Cardioplegia Maintenance Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72196000801",
      "ndc_label_name": "Cardioplegia Reperfusate 4:1 Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285000801",
      "ndc_label_name": "Cardioplegia Reperfusate 4:1 Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219025801",
      "ndc_label_name": "Cardioplegic Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338034104",
      "ndc_label_name": "Cardioplegic SOLUTION PERFUSION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219025810",
      "ndc_label_name": "Cardioplegic Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "89158500890",
      "ndc_label_name": "CareFine Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89158500800",
      "ndc_label_name": "CareFine Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89158500400",
      "ndc_label_name": "CareFine Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89158500490",
      "ndc_label_name": "CareFine Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89158500600",
      "ndc_label_name": "CareFine Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89158500690",
      "ndc_label_name": "CareFine Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214070721",
      "ndc_label_name": "CareOne Advanced Lancing Dev",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41520000139",
      "ndc_label_name": "CareOne Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41520000140",
      "ndc_label_name": "CareOne Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41520000141",
      "ndc_label_name": "CareOne Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41520000142",
      "ndc_label_name": "CareOne Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41520000143",
      "ndc_label_name": "CareOne Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41520000144",
      "ndc_label_name": "CareOne Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214035721",
      "ndc_label_name": "CareOne Lancet Super Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214015721",
      "ndc_label_name": "CareOne Lancet Thin 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214085021",
      "ndc_label_name": "CareOne Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214083021",
      "ndc_label_name": "CareOne Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214084021",
      "ndc_label_name": "CareOne Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08617155572",
      "ndc_label_name": "CareSens Control A SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85325000003",
      "ndc_label_name": "CareSens Control Solution A/B Solution In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10011073008",
      "ndc_label_name": "CareSens Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85325000054",
      "ndc_label_name": "CareSens Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08617164104",
      "ndc_label_name": "CareSens N Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08617155104",
      "ndc_label_name": "CareSens N Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85325000002",
      "ndc_label_name": "CareSens N Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554010975",
      "ndc_label_name": "CareSens S Control Soln A/B Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08554010976",
      "ndc_label_name": "CareSens S Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08554010974",
      "ndc_label_name": "CareSens S Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393000114",
      "ndc_label_name": "CareTouch 2 CPAP Hose Hanger",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60913002501",
      "ndc_label_name": "CareTouch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393040010",
      "ndc_label_name": "CareTouch Alcohol Prep PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60913002502",
      "ndc_label_name": "CareTouch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393040030",
      "ndc_label_name": "CareTouch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60913002503",
      "ndc_label_name": "CareTouch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393040040",
      "ndc_label_name": "CareTouch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60913002504",
      "ndc_label_name": "CareTouch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393040020",
      "ndc_label_name": "CareTouch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393021201",
      "ndc_label_name": "CareTouch Control Sol Level 2 Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393000109",
      "ndc_label_name": "CareTouch CPAP & BIPAP Hose",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393040170",
      "ndc_label_name": "CareTouch CPAP Mask Wipes",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393040271",
      "ndc_label_name": "CareTouch CPAP Mask Wipes",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393000190",
      "ndc_label_name": "CareTouch CPAP Pre-Wash Soln",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393040102",
      "ndc_label_name": "CareTouch CPAP Tube Brush",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393030101",
      "ndc_label_name": "CareTouch Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393030901",
      "ndc_label_name": "CareTouch Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393031001",
      "ndc_label_name": "CareTouch Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393031101",
      "ndc_label_name": "CareTouch Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393020100",
      "ndc_label_name": "CareTouch Lancing/Ejector",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393010201",
      "ndc_label_name": "CareTouch Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393010301",
      "ndc_label_name": "CareTouch Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393011501",
      "ndc_label_name": "CareTouch Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70393017101",
      "ndc_label_name": "CareTouch Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393017201",
      "ndc_label_name": "CareTouch Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393016901",
      "ndc_label_name": "CareTouch Safety Lancets 26G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393000142",
      "ndc_label_name": "CareTouch Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393021105",
      "ndc_label_name": "CareTouch Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393000811",
      "ndc_label_name": "CareTouch Twist Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393014901",
      "ndc_label_name": "CareTouch Twist Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393000812",
      "ndc_label_name": "CareTouch Twist Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393015001",
      "ndc_label_name": "CareTouch Twist Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393015201",
      "ndc_label_name": "CareTouch Twist Lancets 33G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393000813",
      "ndc_label_name": "CareTouch Twist MC Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70393000131",
      "ndc_label_name": "CareTouch Universl CPAP Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155064731",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781347432",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702036603",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54879003664",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702036199",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860022361",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598062857",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155079041",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155064941",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288012690",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205019701",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598086111",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860022130",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121148202",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710152509",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205019801",
      "ndc_label_name": "Carmustine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242004164",
      "ndc_label_name": "Cathflo Activase SOLUTION RECONSTITUTED 2 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242004110",
      "ndc_label_name": "Cathflo Activase Solution Reconstituted 2 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63704002001",
      "ndc_label_name": "Caya DIAPHRAGM VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011801",
      "ndc_label_name": "Celestone Soluspan Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944417910",
      "ndc_label_name": "Ceprotin SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944417705",
      "ndc_label_name": "Ceprotin SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156002205",
      "ndc_label_name": "Ceretec Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156002305",
      "ndc_label_name": "Ceretec Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156002505",
      "ndc_label_name": "Ceretec Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72874000101",
      "ndc_label_name": "Cerianna Solution 4-100 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55566280001",
      "ndc_label_name": "Cervidil INSERT 10 MG VAGINAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50924051310",
      "ndc_label_name": "Chemstrip uGK STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67066000501",
      "ndc_label_name": "ChiRhoStim SOLUTION RECONSTITUTED 16 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143920910",
      "ndc_label_name": "Chloroprocaine HCl (PF) SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143920901",
      "ndc_label_name": "Chloroprocaine HCl (PF) SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143921010",
      "ndc_label_name": "Chloroprocaine HCl (PF) SOLUTION 3 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143921001",
      "ndc_label_name": "Chloroprocaine HCl (PF) SOLUTION 3 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40423050022",
      "ndc_label_name": "Chosen Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40423050021",
      "ndc_label_name": "Chosen Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40423050023",
      "ndc_label_name": "Chosen Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61314062494",
      "ndc_label_name": "Cimerli Solution 0.3 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70114044001",
      "ndc_label_name": "Cimerli Solution 0.3 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70114044101",
      "ndc_label_name": "Cimerli Solution 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314062594",
      "ndc_label_name": "Cimerli Solution 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409109802",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409554710",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409554701",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031302",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939601",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315095",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409109812",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703203301",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071205",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021066805",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703203303",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323041605",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315075",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150028401",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069014101",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031310",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072096",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323041601",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072095",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071206",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150028410",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069014110",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 10 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409367001",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143916001",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409110301",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031210",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409110311",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143916010",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031202",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703204501",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315395",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409367010",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021066920",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071321",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703204503",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069015101",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710153406",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485051301",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485051310",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323041820",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710153401",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006701",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315380",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071320",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323041801",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006710",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013701",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069015110",
      "ndc_label_name": "Cisatracurium Besylate (PF) Solution 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409708301",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703205603",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703205601",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939701",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939710",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150028601",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315295",
      "ndc_label_name": "Cisatracurium Besylate SOLUTION 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323041701",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409708310",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323041710",
      "ndc_label_name": "Cisatracurium Besylate SOLUTION 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071410",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409120801",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781315270",
      "ndc_label_name": "Cisatracurium Besylate SOLUTION 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071411",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031402",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409120811",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069016101",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031410",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067010",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069016110",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150028610",
      "ndc_label_name": "Cisatracurium Besylate Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950501",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025351",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028333",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028838",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010365",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703574811",
      "ndc_label_name": "CISplatin SOLUTION 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020651",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025301",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028332",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001060933",
      "ndc_label_name": "CISplatin Solution 100 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567051101",
      "ndc_label_name": "CISplatin Solution 200 MG/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010364",
      "ndc_label_name": "CISplatin Solution 200 MG/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950401",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028811",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001060824",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028324",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703574711",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025350",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505627900",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010351",
      "ndc_label_name": "CISplatin SOLUTION 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505627700",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001028327",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020650",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025201",
      "ndc_label_name": "CISplatin Solution 50 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567053001",
      "ndc_label_name": "CISplatin Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987101",
      "ndc_label_name": "Cladribine Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658001001",
      "ndc_label_name": "Cladribine Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658001091",
      "ndc_label_name": "Cladribine Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323014010",
      "ndc_label_name": "Cladribine SOLUTION 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457045010",
      "ndc_label_name": "Cladribine Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294305",
      "ndc_label_name": "Clariscan Solution 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294306",
      "ndc_label_name": "Clariscan Solution 2.5 MMOL/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294301",
      "ndc_label_name": "Clariscan Solution 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294370",
      "ndc_label_name": "Clariscan Solution 50 MMOL/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294302",
      "ndc_label_name": "Clariscan Solution 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294322",
      "ndc_label_name": "Clariscan Solution Prefilled Syringe 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294312",
      "ndc_label_name": "Clariscan Solution Prefilled Syringe 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407294317",
      "ndc_label_name": "Clariscan Solution Prefilled Syringe 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "94542005835",
      "ndc_label_name": "Cleanlet Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94542005830",
      "ndc_label_name": "Cleanlet Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000102",
      "ndc_label_name": "Clever Chek Auto-Code Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000120",
      "ndc_label_name": "Clever Chek Auto-Code Voice STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000118",
      "ndc_label_name": "Clever Chek Auto-Code Voice STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000115",
      "ndc_label_name": "Clever Chek Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000127",
      "ndc_label_name": "Clever Chek Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000108",
      "ndc_label_name": "Clever Chek Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000128",
      "ndc_label_name": "Clever Choice Auto-Code Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014020",
      "ndc_label_name": "Clever Choice Comfort EZ",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000109",
      "ndc_label_name": "Clever Choice Glucose Control Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302000110",
      "ndc_label_name": "Clever Choice Glucose Control Liquid Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50002086047",
      "ndc_label_name": "Clever Choice Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50002086046",
      "ndc_label_name": "Clever Choice Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50002086045",
      "ndc_label_name": "Clever Choice Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000138",
      "ndc_label_name": "Clever Choice Holding Chamber DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "98302000139",
      "ndc_label_name": "Clever Choice Holding Chamber DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "98302000143",
      "ndc_label_name": "Clever Choice Holding Chamber DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "98302001424",
      "ndc_label_name": "Clever Choice Lancets 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302001422",
      "ndc_label_name": "Clever Choice Lancets 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014204",
      "ndc_label_name": "Clever Choice Lancets 23G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302001421",
      "ndc_label_name": "Clever Choice Lancets 23G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014023",
      "ndc_label_name": "Clever Choice Lancets 23G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302001420",
      "ndc_label_name": "Clever Choice Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302001407",
      "ndc_label_name": "Clever Choice Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014200",
      "ndc_label_name": "Clever Choice Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000170",
      "ndc_label_name": "Clever Choice Micro Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302013942",
      "ndc_label_name": "Clever Choice No Coding STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50002086038",
      "ndc_label_name": "Clever Choice Peak Flow Meter Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302000191",
      "ndc_label_name": "Clever Choice Talk System STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00338702001",
      "ndc_label_name": "Clinimix E/Dextrose (2.75/5) Solution 2.75 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702006",
      "ndc_label_name": "Clinimix E/Dextrose (2.75/5) Solution 2.75 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338114203",
      "ndc_label_name": "Clinimix E/Dextrose (2.75/5) SOLUTION 2.75 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702804",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/10) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338114503",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/10) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338111504",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/10) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702601",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/10) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702801",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/10) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702606",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/10) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702401",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338114403",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/5) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702206",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338111304",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/5) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702404",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338702201",
      "ndc_label_name": "Clinimix E/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338112304",
      "ndc_label_name": "Clinimix E/Dextrose (5/15) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703201",
      "ndc_label_name": "Clinimix E/Dextrose (5/15) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338114703",
      "ndc_label_name": "Clinimix E/Dextrose (5/15) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703006",
      "ndc_label_name": "Clinimix E/Dextrose (5/15) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703001",
      "ndc_label_name": "Clinimix E/Dextrose (5/15) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703204",
      "ndc_label_name": "Clinimix E/Dextrose (5/15) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703401",
      "ndc_label_name": "Clinimix E/Dextrose (5/20) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338112504",
      "ndc_label_name": "Clinimix E/Dextrose (5/20) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338114803",
      "ndc_label_name": "Clinimix E/Dextrose (5/20) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703604",
      "ndc_label_name": "Clinimix E/Dextrose (5/20) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703406",
      "ndc_label_name": "Clinimix E/Dextrose (5/20) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338703601",
      "ndc_label_name": "Clinimix E/Dextrose (5/20) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338021001",
      "ndc_label_name": "Clinimix E/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338021404",
      "ndc_label_name": "Clinimix E/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338021006",
      "ndc_label_name": "Clinimix E/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338021401",
      "ndc_label_name": "Clinimix E/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338020604",
      "ndc_label_name": "Clinimix E/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338020201",
      "ndc_label_name": "Clinimix E/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338020601",
      "ndc_label_name": "Clinimix E/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338020206",
      "ndc_label_name": "Clinimix E/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113403",
      "ndc_label_name": "Clinimix/Dextrose (4.25/10) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338109104",
      "ndc_label_name": "Clinimix/Dextrose (4.25/10) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338700101",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338700106",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113303",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338108904",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) SOLUTION 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338700304",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338700301",
      "ndc_label_name": "Clinimix/Dextrose (4.25/5) Solution 4.25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338701104",
      "ndc_label_name": "Clinimix/Dextrose (5/15) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113703",
      "ndc_label_name": "Clinimix/Dextrose (5/15) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338109904",
      "ndc_label_name": "Clinimix/Dextrose (5/15) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338701101",
      "ndc_label_name": "Clinimix/Dextrose (5/15) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338701504",
      "ndc_label_name": "Clinimix/Dextrose (5/20) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338701501",
      "ndc_label_name": "Clinimix/Dextrose (5/20) Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338110104",
      "ndc_label_name": "Clinimix/Dextrose (5/20) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113803",
      "ndc_label_name": "Clinimix/Dextrose (5/20) SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019801",
      "ndc_label_name": "Clinimix/Dextrose (6/5) Solution 6 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019806",
      "ndc_label_name": "Clinimix/Dextrose (6/5) Solution 6 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018801",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019404",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338019401",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018806",
      "ndc_label_name": "Clinimix/Dextrose (8/10) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018006",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018001",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018404",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338018401",
      "ndc_label_name": "Clinimix/Dextrose (8/14) Solution 8 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338050203",
      "ndc_label_name": "Clinisol SF SOLUTION 15 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338050206",
      "ndc_label_name": "Clinisol SF SOLUTION 15 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954001",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954006",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954004",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954008",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954003",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954002",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954007",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954005",
      "ndc_label_name": "Clinolipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266010801",
      "ndc_label_name": "Clofarabine Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323057270",
      "ndc_label_name": "Clofarabine SOLUTION 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955174601",
      "ndc_label_name": "Clofarabine Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598030920",
      "ndc_label_name": "Clofarabine SOLUTION 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457054620",
      "ndc_label_name": "Clofarabine Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505616600",
      "ndc_label_name": "Clofarabine Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288012820",
      "ndc_label_name": "Clofarabine Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121123601",
      "ndc_label_name": "Clofarabine SOLUTION 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462102010",
      "ndc_label_name": "CO Monitor DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462102008",
      "ndc_label_name": "CO Monitor Replacement Pieces",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50924004301",
      "ndc_label_name": "CoaguChek Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "64950036204",
      "ndc_label_name": "Cocaine HCl Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527197174",
      "ndc_label_name": "Cocaine HCl Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527197173",
      "ndc_label_name": "Cocaine HCl Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70839036204",
      "ndc_label_name": "Cocaine HCl Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81665030102",
      "ndc_label_name": "Cocaine HCl Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143944301",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789020107",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822061502",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789020105",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143944312",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822061501",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039306",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023013101",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594002301",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155019331",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023013106",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155019341",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594002304",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594002309",
      "ndc_label_name": "Colistimethate Sodium (CBA) Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242012701",
      "ndc_label_name": "Columvi Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242012501",
      "ndc_label_name": "Columvi Solution 2.5 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023010706",
      "ndc_label_name": "Coly-Mycin M Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023010701",
      "ndc_label_name": "Coly-Mycin M Solution Reconstituted 150 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917011815",
      "ndc_label_name": "Comfort Assured Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011816",
      "ndc_label_name": "Comfort Assured Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011817",
      "ndc_label_name": "Comfort Assured Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014043",
      "ndc_label_name": "Comfort EZ Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013939",
      "ndc_label_name": "Comfort EZ Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013940",
      "ndc_label_name": "Comfort EZ Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013941",
      "ndc_label_name": "Comfort EZ Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013937",
      "ndc_label_name": "Comfort EZ Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013938",
      "ndc_label_name": "Comfort EZ Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013934",
      "ndc_label_name": "Comfort EZ Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013935",
      "ndc_label_name": "Comfort EZ Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013936",
      "ndc_label_name": "Comfort EZ Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013932",
      "ndc_label_name": "Comfort EZ Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302014044",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302014045",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014046",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302013920",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50002086020",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013930",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302013919",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50002086019",
      "ndc_label_name": "Comfort EZ Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50002086005",
      "ndc_label_name": "Comfort EZ Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302000199",
      "ndc_label_name": "Comfort EZ Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50002086003",
      "ndc_label_name": "Comfort EZ Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302001430",
      "ndc_label_name": "Comfort EZ Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302000198",
      "ndc_label_name": "Comfort EZ Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302001432",
      "ndc_label_name": "Comfort EZ Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302014059",
      "ndc_label_name": "Comfort EZ Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302001433",
      "ndc_label_name": "Comfort EZ Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302001435",
      "ndc_label_name": "Comfort EZ Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302014174",
      "ndc_label_name": "Comfort EZ Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50002086071",
      "ndc_label_name": "Comfort EZ Pro Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50002086002",
      "ndc_label_name": "Comfort EZ Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317441601",
      "ndc_label_name": "Comfort Touch Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317446505",
      "ndc_label_name": "Comfort Touch Insulin Pen Need 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317446508",
      "ndc_label_name": "Comfort Touch Insulin Pen Need 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317446304",
      "ndc_label_name": "Comfort Touch Insulin Pen Need 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317446306",
      "ndc_label_name": "Comfort Touch Insulin Pen Need 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317461001",
      "ndc_label_name": "Comfort Touch Lancets 31G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73317661001",
      "ndc_label_name": "Comfort Touch Lancets 31G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73317468301",
      "ndc_label_name": "Comfort Touch Plus Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73317668301",
      "ndc_label_name": "Comfort Touch Plus Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73317468201",
      "ndc_label_name": "Comfort Touch Plus Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73317491901",
      "ndc_label_name": "Comfort Touch Twist Lancet 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42135010000",
      "ndc_label_name": "Compact Space Chamber DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42135010003",
      "ndc_label_name": "Compact Space Chamber/Lg Mask DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42135010010",
      "ndc_label_name": "Compact Space Chamber/Lg Mask Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42135010002",
      "ndc_label_name": "Compact Space Chamber/Med Mask DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42135010009",
      "ndc_label_name": "Compact Space Chamber/Med Mask Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42135010001",
      "ndc_label_name": "Compact Space Chamber/Sm Mask DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42135010008",
      "ndc_label_name": "Compact Space Chamber/Sm Mask Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63044003112",
      "ndc_label_name": "Condoms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193954501",
      "ndc_label_name": "Contour Blood Glucose System Kit w/Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193711101",
      "ndc_label_name": "Contour Control Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193711001",
      "ndc_label_name": "Contour Control Liquid Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193710901",
      "ndc_label_name": "Contour Control Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193731501",
      "ndc_label_name": "Contour Next Control Solution Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193731401",
      "ndc_label_name": "Contour Next Control Solution Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193727735",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193731150",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193731310",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193731025",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193727870",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518062800",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193731221",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090708400",
      "ndc_label_name": "Contour Next Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193759401",
      "ndc_label_name": "Contour Plus Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193759301",
      "ndc_label_name": "Contour Plus Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193758450",
      "ndc_label_name": "Contour Plus Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193707025",
      "ndc_label_name": "Contour Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518169300",
      "ndc_label_name": "Contour Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193708050",
      "ndc_label_name": "Contour Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193709021",
      "ndc_label_name": "Contour Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08617194104",
      "ndc_label_name": "Cool Blood Glucose Test Strips STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08617194568",
      "ndc_label_name": "Cool Control A SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08617194567",
      "ndc_label_name": "Cool Control B SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00548590000",
      "ndc_label_name": "Cortrosyn SOLUTION RECONSTITUTED 0.25 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090454701",
      "ndc_label_name": "Cortrosyn Solution Reconstituted 0.25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009379401",
      "ndc_label_name": "Corvert SOLUTION 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009379422",
      "ndc_label_name": "Corvert SOLUTION 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73594010101",
      "ndc_label_name": "Cosela Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73462010101",
      "ndc_label_name": "Cosela Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781344095",
      "ndc_label_name": "Cosyntropin Solution Reconstituted 0.25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022702",
      "ndc_label_name": "Cosyntropin Solution Reconstituted 0.25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781344071",
      "ndc_label_name": "Cosyntropin Solution Reconstituted 0.25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022700",
      "ndc_label_name": "Cosyntropin Solution Reconstituted 0.25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50633011011",
      "ndc_label_name": "CroFab Solution Reconstituted Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50633011012",
      "ndc_label_name": "CroFab SOLUTION RECONSTITUTED Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080925200",
      "ndc_label_name": "Curafil Wound Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080575000",
      "ndc_label_name": "Curity Alcohol Preps PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080102200",
      "ndc_label_name": "Curity Sterile Saline Solution 0.9 % Irrigation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122051001",
      "ndc_label_name": "Curosurf SUSPENSION 120 MG/1.5ML Intratracheal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122051003",
      "ndc_label_name": "Curosurf SUSPENSION 240 MG/3ML Intratracheal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069106101",
      "ndc_label_name": "Cutaquig Solution 1 GM/6ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069106102",
      "ndc_label_name": "Cutaquig Solution 1 GM/6ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081001",
      "ndc_label_name": "Cutaquig Solution 1 GM/6ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081081",
      "ndc_label_name": "Cutaquig Solution 1 GM/6ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081082",
      "ndc_label_name": "Cutaquig Solution 1.65 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081002",
      "ndc_label_name": "Cutaquig Solution 1.65 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069147601",
      "ndc_label_name": "Cutaquig Solution 2 GM/12ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069147602",
      "ndc_label_name": "Cutaquig Solution 2 GM/12ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081003",
      "ndc_label_name": "Cutaquig Solution 2 GM/12ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081083",
      "ndc_label_name": "Cutaquig Solution 2 GM/12ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081004",
      "ndc_label_name": "Cutaquig Solution 3.3 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081084",
      "ndc_label_name": "Cutaquig Solution 3.3 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081005",
      "ndc_label_name": "Cutaquig Solution 4 GM/24ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081085",
      "ndc_label_name": "Cutaquig Solution 4 GM/24ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069150901",
      "ndc_label_name": "Cutaquig Solution 4 GM/24ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069150902",
      "ndc_label_name": "Cutaquig Solution 4 GM/24ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069196501",
      "ndc_label_name": "Cutaquig Solution 8 GM/48ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081006",
      "ndc_label_name": "Cutaquig Solution 8 GM/48ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982081086",
      "ndc_label_name": "Cutaquig Solution 8 GM/48ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069196502",
      "ndc_label_name": "Cutaquig Solution 8 GM/48ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285002",
      "ndc_label_name": "Cuvitru SOLUTION 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285001",
      "ndc_label_name": "Cuvitru SOLUTION 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285009",
      "ndc_label_name": "Cuvitru Solution 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285010",
      "ndc_label_name": "Cuvitru Solution 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285004",
      "ndc_label_name": "Cuvitru SOLUTION 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285003",
      "ndc_label_name": "Cuvitru SOLUTION 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285005",
      "ndc_label_name": "Cuvitru SOLUTION 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285006",
      "ndc_label_name": "Cuvitru SOLUTION 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285008",
      "ndc_label_name": "Cuvitru SOLUTION 8 GM/40ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944285007",
      "ndc_label_name": "Cuvitru SOLUTION 8 GM/40ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50428046735",
      "ndc_label_name": "CVS Advanced Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08396500375",
      "ndc_label_name": "CVS Advanced Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08396500475",
      "ndc_label_name": "CVS Advanced Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08396500575",
      "ndc_label_name": "CVS Advanced Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428049095",
      "ndc_label_name": "CVS Advanced Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428034618",
      "ndc_label_name": "CVS Alcohol Prep Pads PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428041039",
      "ndc_label_name": "CVS Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428054214",
      "ndc_label_name": "CVS Glucose Meter Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428306422",
      "ndc_label_name": "CVS Ketone Care STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59779032304",
      "ndc_label_name": "CVS Lancets Original",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396030176",
      "ndc_label_name": "CVS Lancets Thin 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396030175",
      "ndc_label_name": "CVS Lancets Thin 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396050175",
      "ndc_label_name": "CVS Lancets Thin 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428001771",
      "ndc_label_name": "CVS Lancets Thin 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396050375",
      "ndc_label_name": "CVS Lancets Thin 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396051075",
      "ndc_label_name": "CVS Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428035127",
      "ndc_label_name": "CVS Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428045254",
      "ndc_label_name": "CVS Manuka Honey Wound Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428053982",
      "ndc_label_name": "CVS Manuka Honey Wound Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428047377",
      "ndc_label_name": "CVS Prep PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428085942",
      "ndc_label_name": "CVS Prep PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428059453",
      "ndc_label_name": "CVS True Metrix Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428008739",
      "ndc_label_name": "CVS True Metrix Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428235157",
      "ndc_label_name": "CVS Ultra Thin Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002766901",
      "ndc_label_name": "Cyramza SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002767801",
      "ndc_label_name": "Cyramza SOLUTION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021022320",
      "ndc_label_name": "Cytarabine (PF) Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703015501",
      "ndc_label_name": "Cytarabine (PF) Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703031922",
      "ndc_label_name": "Cytarabine (PF) SOLUTION 100 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010920",
      "ndc_label_name": "Cytarabine (PF) Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323012020",
      "ndc_label_name": "Cytarabine (PF) SOLUTION 100 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030346",
      "ndc_label_name": "Cytarabine (PF) Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457045500",
      "ndc_label_name": "Cytarabine (PF) Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457045552",
      "ndc_label_name": "Cytarabine (PF) Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021022905",
      "ndc_label_name": "Cytarabine (PF) Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030538",
      "ndc_label_name": "Cytarabine (PF) Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030558",
      "ndc_label_name": "Cytarabine (PF) Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030436",
      "ndc_label_name": "Cytarabine SOLUTION 20 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591053251",
      "ndc_label_name": "Cytogam Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206053211",
      "ndc_label_name": "Cytogam Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257053251",
      "ndc_label_name": "Cytogam Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591053250",
      "ndc_label_name": "Cytogam Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206053290",
      "ndc_label_name": "Cytogam Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257053250",
      "ndc_label_name": "Cytogam Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70914000305",
      "ndc_label_name": "D-Care Blood Glucose STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323012700",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323012710",
      "ndc_label_name": "Dacarbazine SOLUTION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703507503",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924501",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703507501",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323012800",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017421",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323012820",
      "ndc_label_name": "Dacarbazine SOLUTION RECONSTITUTED 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017420",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924510",
      "ndc_label_name": "Dacarbazine Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993048983",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822210002",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822210001",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457051305",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043101",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658000801",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457092802",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150092802",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288012902",
      "ndc_label_name": "DACTINomycin Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73042020101",
      "ndc_label_name": "Danyelza Solution 40 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281028610",
      "ndc_label_name": "Daptacel Suspension 23-15-5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281028658",
      "ndc_label_name": "Daptacel Suspension 23-15-5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017916",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017967",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409012001",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323058515",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143945501",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043445",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017966",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097085067",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001046741",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017915",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043405",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603014701",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839010801",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598047611",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722021501",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288001791",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594006601",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572010001",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594005301",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288001715",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017416",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457094115",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143946501",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143937801",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409012201",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143944401",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143944501",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781329570",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722010210",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288001810",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714089201",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409275701",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023029501",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594003401",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043505",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017415",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598041311",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288001615",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722021601",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457081350",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023029510",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594003402",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150034401",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572010201",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622904",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594006001",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839010701",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288001691",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001037668",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323037110",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288001695",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090001101",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097080737",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377009391",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572015801",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603015201",
      "ndc_label_name": "DAPTOmycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338071812",
      "ndc_label_name": "DAPTOmycin-Sodium Chloride Solution 1000-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338171812",
      "ndc_label_name": "DAPTOmycin-Sodium Chloride Solution 1000-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338071224",
      "ndc_label_name": "DAPTOmycin-Sodium Chloride Solution 350-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338071424",
      "ndc_label_name": "DAPTOmycin-Sodium Chloride Solution 500-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338171612",
      "ndc_label_name": "DAPTOmycin-Sodium Chloride Solution 700-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338071612",
      "ndc_label_name": "DAPTOmycin-Sodium Chloride Solution 700-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894050301",
      "ndc_label_name": "Darzalex Faspro Solution 1800-30000 MG-UT/15ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894050505",
      "ndc_label_name": "Darzalex Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894050205",
      "ndc_label_name": "Darzalex Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894050520",
      "ndc_label_name": "Darzalex Solution 400 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894050220",
      "ndc_label_name": "Darzalex Solution 400 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597080101",
      "ndc_label_name": "Datroway Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156021001",
      "ndc_label_name": "DaTscan Solution 185 MBQ/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703523313",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955101",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658002192",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955110",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658002101",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658002102",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288018205",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703523311",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658002191",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288018204",
      "ndc_label_name": "DAUNOrubicin HCl Solution 20 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42658001901",
      "ndc_label_name": "DAUNOrubicin HCl Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955001",
      "ndc_label_name": "DAUNOrubicin HCl Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143938501",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097090567",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781329680",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150037601",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335036141",
      "ndc_label_name": "Decitabine SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729022405",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023120",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714092801",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742043001",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205003601",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598042737",
      "ndc_label_name": "Decitabine SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097028537",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162263402",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021021920",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001057341",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030431",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111055610",
      "ndc_label_name": "Decitabine SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001042237",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061837",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021920",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082520",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598034837",
      "ndc_label_name": "Decitabine SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064241",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603010701",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834019001",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457031625",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121164401",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011920",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205003101",
      "ndc_label_name": "Decitabine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074028202",
      "ndc_label_name": "Decnupaz Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781062407",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52609450401",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409233725",
      "ndc_label_name": "Deferoxamine Mesylate SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059930",
      "ndc_label_name": "Deferoxamine Mesylate SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409233715",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52609450406",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623700",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623706",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52609450501",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52609450506",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623606",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623800",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059710",
      "ndc_label_name": "Deferoxamine Mesylate SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623600",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623806",
      "ndc_label_name": "Deferoxamine Mesylate Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994001720",
      "ndc_label_name": "Definity RT Suspension 6.52 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994001104",
      "ndc_label_name": "Definity Suspension 6.52 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994001116",
      "ndc_label_name": "Definity Suspension 6.52 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727080001",
      "ndc_label_name": "Defitelio Solution 200 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727080002",
      "ndc_label_name": "Defitelio Solution 200 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090764301",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822930001",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729071045",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991099975",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729071031",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82983042610",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090764300",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991099917",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822930002",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729071053",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82983042601",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634030605",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634030641",
      "ndc_label_name": "Dehydrated Alcohol Solution Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409117630",
      "ndc_label_name": "Demerol SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409117603",
      "ndc_label_name": "Demerol SOLUTION 25 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409136211",
      "ndc_label_name": "Demerol Solution 25 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409136201",
      "ndc_label_name": "Demerol Solution 25 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409117830",
      "ndc_label_name": "Demerol SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409117803",
      "ndc_label_name": "Demerol SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141801",
      "ndc_label_name": "Demerol Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409118130",
      "ndc_label_name": "Demerol SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141811",
      "ndc_label_name": "Demerol Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79043015028",
      "ndc_label_name": "Derpixa Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078046791",
      "ndc_label_name": "Desferal SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078046761",
      "ndc_label_name": "Desferal SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781617286",
      "ndc_label_name": "Desflurane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781617222",
      "ndc_label_name": "Desflurane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69945006401",
      "ndc_label_name": "Detectnet Solution 1 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090636500",
      "ndc_label_name": "Dexcom G6 Receiver Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627009111",
      "ndc_label_name": "Dexcom G6 Receiver Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627005303",
      "ndc_label_name": "Dexcom G6 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090636400",
      "ndc_label_name": "Dexcom G6 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627001601",
      "ndc_label_name": "Dexcom G6 Transmitter",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090636600",
      "ndc_label_name": "Dexcom G6 Transmitter",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791600",
      "ndc_label_name": "Dexcom G7 15 Day Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627007901",
      "ndc_label_name": "Dexcom G7 15 Day Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627007801",
      "ndc_label_name": "Dexcom G7 Receiver Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642900",
      "ndc_label_name": "Dexcom G7 Receiver Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643000",
      "ndc_label_name": "Dexcom G7 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627007701",
      "ndc_label_name": "Dexcom G7 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143919801",
      "ndc_label_name": "dexmedeTOMIDine HCl in NaCl Solution 1000 MCG/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143919810",
      "ndc_label_name": "dexmedeTOMIDine HCl in NaCl Solution 1000 MCG/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143952601",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338955524",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536012501",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023018620",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349495",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323067105",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023402",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021061550",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143952610",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457092450",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536012510",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457092400",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066055524",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323067150",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121138801",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598097658",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121171101",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094014720",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150029601",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225013202",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066056124",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225012605",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121138808",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023444",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598097611",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572012701",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150029610",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094014701",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121171102",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225012602",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121171109",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225013201",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572012710",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066055712",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023018710",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066056512",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143952501",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021061551",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094024710",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143952510",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338955712",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572012801",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023541",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150029701",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023018701",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121171201",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094024701",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021061782",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349595",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225012606",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121138907",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598097511",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536012601",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225013301",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225013302",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598097558",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121138901",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572012808",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150029710",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536012608",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225012603",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323067100",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323067101",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457092500",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023502",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457092510",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121171202",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121171203",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323067120",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 80 MCG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323067102",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 80 MCG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349395",
      "ndc_label_name": "Dexmedetomidine HCl in NaCl Solution 80 MCG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567060104",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 1000 MCG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075904",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 1000 MCG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075901",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 1000 MCG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150020902",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143953225",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478005502",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043230",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729023993",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729023930",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143953201",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664059640",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023002",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023342",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664059650",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042102",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043293",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023014625",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457025100",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042101",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023302",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860060502",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023042",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457025102",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288050503",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288050502",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860060503",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860060541",
      "ndc_label_name": "Dexmedetomidine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634060002",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567060004",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 400 MCG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075801",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 400 MCG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075804",
      "ndc_label_name": "dexmedeTOMIDine HCl Solution 400 MCG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567060224",
      "ndc_label_name": "Dexmedetomidine HCl-Dextrose Solution 200MCG/50ML -5% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567060324",
      "ndc_label_name": "Dexmedetomidine HCl-Dextrose Solution 400MCG/100ML -5% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205024701",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924701",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457020425",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043402",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043202",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457020725",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266023501",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043201",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043401",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924801",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266010101",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205024801",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043501",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457020850",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991094298",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611071672",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043701",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457020950",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611071601",
      "ndc_label_name": "Dexrazoxane HCl Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70382020499",
      "ndc_label_name": "Dextenza Insert 0.4 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70382020410",
      "ndc_label_name": "Dextenza Insert 0.4 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70382020401",
      "ndc_label_name": "Dextenza Insert 0.4 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792909",
      "ndc_label_name": "Dextrose in Lactated Ringers Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792903",
      "ndc_label_name": "Dextrose in Lactated Ringers Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775100",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219024350",
      "ndc_label_name": "Dextrose in Lactated Ringers Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775110",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338012504",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338012503",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219024301",
      "ndc_label_name": "Dextrose in Lactated Ringers Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338002303",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264752020",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990793002",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264752000",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264752010",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072105",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082425",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082426",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338002304",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338002302",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082474",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990793819",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990793009",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072106",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082476",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082475",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990793003",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072107",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082424",
      "ndc_label_name": "Dextrose Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990793519",
      "ndc_label_name": "Dextrose Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092147446",
      "ndc_label_name": "Dextrose Solution 250 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409177510",
      "ndc_label_name": "Dextrose SOLUTION 250 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409177540",
      "ndc_label_name": "Dextrose Solution 250 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990800415",
      "ndc_label_name": "Dextrose Solution 30 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990793719",
      "ndc_label_name": "Dextrose Solution 40 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264151031",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264151032",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001718",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264751010",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001738",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001703",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264751000",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001741",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264751020",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001710",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001748",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001711",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007820",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338006230",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001702",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007430",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338914730",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338006620",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008212",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792225",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710066",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338055111",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001704",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710068",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338966440",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710002",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338055118",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792311",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710069",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338914330",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001731",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072007",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338966635",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792202",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710004",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062410",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792209",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710067",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007010",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062404",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072003",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792203",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792261",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062475",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792306",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792323",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338964975",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062407",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219023410",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072002",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792313",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046005",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046205",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072006",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338965360",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219023801",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046405",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271072005",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792336",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219045605",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046210",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062405",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792255",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219045805",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046450",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219023601",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792337",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219023610",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792320",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219024001",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062474",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062403",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219023401",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062406",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219045660",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062450",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219045830",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062461",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219023825",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219024050",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046020",
      "ndc_label_name": "Dextrose Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374095350",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409751716",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409664802",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092147550",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409664816",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329330101",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409490234",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329330201",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409751766",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990793619",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409490264",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73702010465",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090294201",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090188901",
      "ndc_label_name": "Dextrose Solution 50 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338071906",
      "ndc_label_name": "Dextrose Solution 70 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990712007",
      "ndc_label_name": "Dextrose Solution 70 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266071201",
      "ndc_label_name": "Dextrose Solution 70 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338978904",
      "ndc_label_name": "Dextrose Solution 70 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264738750",
      "ndc_label_name": "Dextrose Solution 70 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338978901",
      "ndc_label_name": "Dextrose Solution 70 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990791819",
      "ndc_label_name": "Dextrose Solution 70 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338979901",
      "ndc_label_name": "Dextrose-NaCl Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338979912",
      "ndc_label_name": "Dextrose-NaCl Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264762320",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 10-0.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264762200",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 10-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087410",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 2.5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007304",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 2.5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761610",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007702",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007703",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761600",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761620",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007704",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409792403",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792409",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409792409",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792403",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792402",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087310",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087374",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087375",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.225 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086710",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.3 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792503",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.3 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792509",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.3 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086775",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.3 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086774",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.3 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761410",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.33 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008103",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.33 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792603",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761200",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792602",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409792603",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008503",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086904",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086974",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761210",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792609",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008504",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086901",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086905",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086975",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086910",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.45 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087010",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761000",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409794103",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087001",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008903",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008904",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087074",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323087004",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990794103",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264761010",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990794109",
      "ndc_label_name": "Dextrose-Sodium Chloride Solution 5-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60010019570",
      "ndc_label_name": "Diabetic Hydrogel Wound Dress Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56153000832",
      "ndc_label_name": "Diathrive Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000833",
      "ndc_label_name": "Diathrive Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000834",
      "ndc_label_name": "Diathrive Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000803",
      "ndc_label_name": "Diathrive Glucose Control Soln Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56153000814",
      "ndc_label_name": "Diathrive Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000809",
      "ndc_label_name": "Diathrive Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000808",
      "ndc_label_name": "Diathrive Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000802",
      "ndc_label_name": "Diathrive Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000810",
      "ndc_label_name": "Diathrive Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000807",
      "ndc_label_name": "Diathrive Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000813",
      "ndc_label_name": "Diathrive Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000828",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000827",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000830",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000824",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000829",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000831",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000826",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000825",
      "ndc_label_name": "Diathrive Lancet Ultra Thin 30",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000816",
      "ndc_label_name": "Diathrive Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000815",
      "ndc_label_name": "Diathrive Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000805",
      "ndc_label_name": "Diathrive Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56153000822",
      "ndc_label_name": "Diathrive Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56153000823",
      "ndc_label_name": "Diathrive Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56153000854",
      "ndc_label_name": "Diathrive+ Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000852",
      "ndc_label_name": "Diathrive+ Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000851",
      "ndc_label_name": "Diathrive+ Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000850",
      "ndc_label_name": "Diathrive+ Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000812",
      "ndc_label_name": "Diathrive+ Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000855",
      "ndc_label_name": "Diathrive+ Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56153000853",
      "ndc_label_name": "Diathrive+ Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31722001912",
      "ndc_label_name": "Diatrizoate Meglumine & Sodium Solution 66-10 % Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722001930",
      "ndc_label_name": "Diatrizoate Meglumine & Sodium Solution 66-10 % Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722001932",
      "ndc_label_name": "Diatrizoate Meglumine & Sodium Solution 66-10 % Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722001931",
      "ndc_label_name": "Diatrizoate Meglumine & Sodium Solution 66-10 % Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045012111",
      "ndc_label_name": "Dilaudid Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045012101",
      "ndc_label_name": "Dilaudid Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000910",
      "ndc_label_name": "Dilaudid Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000901",
      "ndc_label_name": "Dilaudid Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000905",
      "ndc_label_name": "Dilaudid Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000996",
      "ndc_label_name": "Dilaudid Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000906",
      "ndc_label_name": "Dilaudid Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000911",
      "ndc_label_name": "Dilaudid Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045001011",
      "ndc_label_name": "Dilaudid Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045001001",
      "ndc_label_name": "Dilaudid Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045001010",
      "ndc_label_name": "Dilaudid Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219080001",
      "ndc_label_name": "Diprivan +RFID Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219080010",
      "ndc_label_name": "Diprivan +RFID Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026901",
      "ndc_label_name": "Diprivan Emulsion 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026906",
      "ndc_label_name": "Diprivan Emulsion 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026910",
      "ndc_label_name": "Diprivan Emulsion 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026916",
      "ndc_label_name": "Diprivan Emulsion 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026967",
      "ndc_label_name": "Diprivan EMULSION 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026965",
      "ndc_label_name": "Diprivan EMULSION 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026935",
      "ndc_label_name": "Diprivan Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026931",
      "ndc_label_name": "Diprivan Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026941",
      "ndc_label_name": "Diprivan Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026921",
      "ndc_label_name": "Diprivan Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026969",
      "ndc_label_name": "Diprivan EMULSION 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026978",
      "ndc_label_name": "Diprivan EMULSION 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026994",
      "ndc_label_name": "Diprivan EMULSION 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026929",
      "ndc_label_name": "Diprivan EMULSION 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026922",
      "ndc_label_name": "Diprivan Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026925",
      "ndc_label_name": "Diprivan Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026937",
      "ndc_label_name": "Diprivan EMULSION 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026933",
      "ndc_label_name": "Diprivan Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026970",
      "ndc_label_name": "Diprivan EMULSION 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026943",
      "ndc_label_name": "Diprivan Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026957",
      "ndc_label_name": "Diprivan EMULSION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026930",
      "ndc_label_name": "Diprivan Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026959",
      "ndc_label_name": "Diprivan EMULSION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026977",
      "ndc_label_name": "Diprivan EMULSION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026923",
      "ndc_label_name": "Diprivan Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026950",
      "ndc_label_name": "Diprivan EMULSION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026945",
      "ndc_label_name": "Diprivan Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026975",
      "ndc_label_name": "Diprivan Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641256941",
      "ndc_label_name": "Dipyridamole SOLUTION 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641256944",
      "ndc_label_name": "Dipyridamole SOLUTION 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234401",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143914110",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436020382",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234468",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143914101",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234488",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234402",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234462",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436020380",
      "ndc_label_name": "DOBUTamine HCl Solution 12.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409002510",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 1-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409002501",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 1-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338107302",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 1-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234631",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 1-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234632",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 1-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409015110",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234731",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409234732",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409015101",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338107502",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409110010",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 4-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409110001",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 4-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338107702",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 4-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372432",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 4-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372411",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 4-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090456200",
      "ndc_label_name": "DOBUTamine-Dextrose Solution 4-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155090531",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729026765",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409036501",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121122301",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409036801",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093940",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955102208",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457078108",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021608",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598038957",
      "ndc_label_name": "DOCEtaxel Concentrate 160 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729026763",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155090331",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955102001",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598025811",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143920401",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409423501",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963073454",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335032340",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121122101",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598061111",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409036601",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021401",
      "ndc_label_name": "DOCEtaxel Concentrate 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021024501",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409506801",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729026764",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143920501",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598025940",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963076552",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155090431",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409036701",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955102104",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021024504",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121122201",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598061040",
      "ndc_label_name": "DOCEtaxel CONCENTRATE 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021504",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089540",
      "ndc_label_name": "DOCEtaxel Concentrate 80 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066004801",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025416",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409020120",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066004816",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001001",
      "ndc_label_name": "DOCEtaxel SOLUTION 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409173201",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332067816",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409001601",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457053316",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742046316",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288014416",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150038001",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66758005003",
      "ndc_label_name": "DOCEtaxel SOLUTION 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700017622",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73358021016",
      "ndc_label_name": "DOCEtaxel Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66758005001",
      "ndc_label_name": "DOCEtaxel SOLUTION 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332067802",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066004401",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457053102",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409020102",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700017422",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409202601",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066000101",
      "ndc_label_name": "DOCEtaxel SOLUTION 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150037801",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066004402",
      "ndc_label_name": "DOCEtaxel Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025408",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742043108",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066004608",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409787001",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700017522",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332067808",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066000601",
      "ndc_label_name": "DOCEtaxel SOLUTION 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409020110",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288014408",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66758005002",
      "ndc_label_name": "DOCEtaxel SOLUTION 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150037901",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066004601",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078004008",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457053208",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73358021008",
      "ndc_label_name": "DOCEtaxel Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831010316",
      "ndc_label_name": "Docivyx Solution 160 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831010102",
      "ndc_label_name": "Docivyx Solution 20 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831010208",
      "ndc_label_name": "Docivyx Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925201",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409582001",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925425",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409910421",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925401",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409582011",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409910420",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925225",
      "ndc_label_name": "DOPamine HCl Solution 40 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338100502",
      "ndc_label_name": "DOPamine-Dextrose Solution 0.8-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338100503",
      "ndc_label_name": "DOPamine-Dextrose Solution 0.8-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409780911",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409780924",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338100702",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409004201",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338100703",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409004212",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409780922",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409780931",
      "ndc_label_name": "DOPamine-Dextrose Solution 1.6-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338100902",
      "ndc_label_name": "DOPamine-Dextrose Solution 3.2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409185812",
      "ndc_label_name": "DOPamine-Dextrose Solution 3.2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409781011",
      "ndc_label_name": "DOPamine-Dextrose Solution 3.2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409185801",
      "ndc_label_name": "DOPamine-Dextrose Solution 3.2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409781022",
      "ndc_label_name": "DOPamine-Dextrose Solution 3.2-5 MG/ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641601801",
      "ndc_label_name": "Dopram SOLUTION 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200003",
      "ndc_label_name": "Dotarem Solution 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200103",
      "ndc_label_name": "Dotarem Solution 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200100",
      "ndc_label_name": "Dotarem Solution 2.5 MMOL/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200000",
      "ndc_label_name": "Dotarem Solution 2.5 MMOL/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200101",
      "ndc_label_name": "Dotarem Solution 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200001",
      "ndc_label_name": "Dotarem Solution 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200104",
      "ndc_label_name": "Dotarem Solution 50 MMOL/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200102",
      "ndc_label_name": "Dotarem Solution 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200002",
      "ndc_label_name": "Dotarem Solution 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200007",
      "ndc_label_name": "Dotarem Solution Prefilled Syringe 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684300103",
      "ndc_label_name": "Dotarem Solution Prefilled Syringe 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684300101",
      "ndc_label_name": "Dotarem Solution Prefilled Syringe 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200005",
      "ndc_label_name": "Dotarem Solution Prefilled Syringe 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684200006",
      "ndc_label_name": "Dotarem Solution Prefilled Syringe 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67684300102",
      "ndc_label_name": "Dotarem Solution Prefilled Syringe 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338006701",
      "ndc_label_name": "Doxil Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338966501",
      "ndc_label_name": "Doxil Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338966701",
      "ndc_label_name": "Doxil Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338006301",
      "ndc_label_name": "Doxil Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714074201",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008001",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629953001",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021026325",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001034528",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598068325",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338008601",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598068235",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714085601",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574093010",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001034536",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001070336",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001049326",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020001",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001034526",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335004940",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598054125",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574093125",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001062926",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748033901",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001034523",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907036301",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001062936",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603050701",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001070426",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021026310",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710153001",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907036401",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603010301",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598028335",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748034001",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335005040",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603034601",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629953101",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001049236",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710153101",
      "ndc_label_name": "DOXOrubicin HCl Liposomal Suspension 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069303020",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069025510",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069303120",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069035820",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069144204",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069154220",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069335825",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069034302",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069401510",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069027702",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069420505",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069403101",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143908701",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069303320",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069402625",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069303220",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143908801",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069562905",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069403701",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714000101",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143909101",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069403112",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963073357",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069303420",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143909001",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143908401",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963073360",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020751",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088330",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143908601",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963073355",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069400405",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756082640",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143908501",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010161",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143908901",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020725",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088310",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088305",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756082740",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963073368",
      "ndc_label_name": "DOXOrubicin HCl SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020805",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020825",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020851",
      "ndc_label_name": "DOXOrubicin HCl Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143909201",
      "ndc_label_name": "DOXOrubicin HCl Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143909301",
      "ndc_label_name": "DOXOrubicin HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457043650",
      "ndc_label_name": "DOXOrubicin HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08489915001",
      "ndc_label_name": "Droplet Genteel Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489605210",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000284",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000285",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489605110",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000282",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000283",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000280",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000281",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489605010",
      "ndc_label_name": "Droplet Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489602809",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489600910",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000271",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000273",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489600810",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000268",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489602709",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000270",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489602609",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489600710",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000267",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000266",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000278",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000279",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489601310",
      "ndc_label_name": "Droplet Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489602009",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000255",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000254",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489600110",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000257",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489600210",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489602109",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59135000256",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489602209",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489600310",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59135000259",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59135000258",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489600610",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59135000265",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489602509",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59135000264",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489602409",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489600510",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000263",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000262",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489602309",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000260",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489600410",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59135000261",
      "ndc_label_name": "Droplet Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489716130",
      "ndc_label_name": "Droplet Lancets Ultra Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08633900001",
      "ndc_label_name": "Droplet Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489831010",
      "ndc_label_name": "Droplet Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489787009",
      "ndc_label_name": "Droplet Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489749710",
      "ndc_label_name": "Droplet Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57273000225",
      "ndc_label_name": "Droplet Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489787209",
      "ndc_label_name": "Droplet Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489749810",
      "ndc_label_name": "Droplet Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489830910",
      "ndc_label_name": "Droplet Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57273000223",
      "ndc_label_name": "Droplet Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489908011",
      "ndc_label_name": "Droplet Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489749610",
      "ndc_label_name": "Droplet Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489831510",
      "ndc_label_name": "Droplet Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489786609",
      "ndc_label_name": "Droplet Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57273000209",
      "ndc_label_name": "Droplet Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57273000299",
      "ndc_label_name": "Droplet Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489831310",
      "ndc_label_name": "Droplet Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489908211",
      "ndc_label_name": "Droplet Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57273000227",
      "ndc_label_name": "Droplet Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489716710",
      "ndc_label_name": "Droplet Personal Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "03999060201",
      "ndc_label_name": "DropSafe Acti-Lance 23G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81603062510",
      "ndc_label_name": "DropSafe Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57273000257",
      "ndc_label_name": "DropSafe Autoprotect Duo 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57273000258",
      "ndc_label_name": "DropSafe Autoprotect Duo 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81603966920",
      "ndc_label_name": "DropSafe Medlance Lancet 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489816110",
      "ndc_label_name": "DropSafe Safety Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489816310",
      "ndc_label_name": "DropSafe Safety Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "03999060072",
      "ndc_label_name": "DropSafe Safety Syringe/Needle 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "03999060078",
      "ndc_label_name": "DropSafe Safety Syringe/Needle 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "03999060077",
      "ndc_label_name": "DropSafe Safety Syringe/Needle 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "03999060079",
      "ndc_label_name": "DropSafe Safety Syringe/Needle 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "03999060069",
      "ndc_label_name": "DropSafe Safety Syringe/Needle 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "03999060071",
      "ndc_label_name": "DropSafe Safety Syringe/Needle 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "03999060073",
      "ndc_label_name": "DropSafe Safety Syringe/Needle 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08214028739",
      "ndc_label_name": "Drug Mart On-The-Go Lancet 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214030739",
      "ndc_label_name": "Drug Mart Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214084739",
      "ndc_label_name": "Drug Mart Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214025739",
      "ndc_label_name": "Drug Mart Unilet Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214065739",
      "ndc_label_name": "Drug Mart Unilet Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214058539",
      "ndc_label_name": "Drug Mart Unilet Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08536012000",
      "ndc_label_name": "Duo-Care Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08536011500",
      "ndc_label_name": "Duo-Care Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08536011000",
      "ndc_label_name": "Duo-Care Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00641602001",
      "ndc_label_name": "Duramorph Solution 0.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602010",
      "ndc_label_name": "Duramorph Solution 0.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641601901",
      "ndc_label_name": "Duramorph Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641601910",
      "ndc_label_name": "Duramorph Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "02340024100",
      "ndc_label_name": "Durex Extra Sensitive Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "02340030271",
      "ndc_label_name": "Durex Extra Sensitive Thin Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "02340099552",
      "ndc_label_name": "Durex Extra Sensitive Thin Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "02340012900",
      "ndc_label_name": "Durex Extra Sensitive Thin Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "02340089456",
      "ndc_label_name": "Durex RealFeel DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "02340089457",
      "ndc_label_name": "Durex RealFeel DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "02340089455",
      "ndc_label_name": "Durex RealFeel DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "02340009000",
      "ndc_label_name": "Durex Tropical",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00299596230",
      "ndc_label_name": "Dysport Solution Reconstituted 300 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15054053006",
      "ndc_label_name": "Dysport SOLUTION RECONSTITUTED 300 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15054050001",
      "ndc_label_name": "Dysport SOLUTION RECONSTITUTED 500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502020725",
      "ndc_label_name": "EasiVent",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502020701",
      "ndc_label_name": "EasiVent",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502020803",
      "ndc_label_name": "EasiVent Mask Large",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502020802",
      "ndc_label_name": "EasiVent Mask Medium",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502020801",
      "ndc_label_name": "EasiVent Mask Small",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50058086417",
      "ndc_label_name": "Easy Air Nebulizer Filters",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60000052657",
      "ndc_label_name": "Easy Comfort Alcohol Pads Pad",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000171",
      "ndc_label_name": "Easy Comfort Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000172",
      "ndc_label_name": "Easy Comfort Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000109",
      "ndc_label_name": "Easy Comfort Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049465",
      "ndc_label_name": "Easy Comfort Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000188",
      "ndc_label_name": "Easy Comfort Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000189",
      "ndc_label_name": "Easy Comfort Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000116",
      "ndc_label_name": "Easy Comfort Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50071076506",
      "ndc_label_name": "Easy Comfort Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000129",
      "ndc_label_name": "Easy Comfort Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000115",
      "ndc_label_name": "Easy Comfort Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000731",
      "ndc_label_name": "Easy Comfort Lancets Twist Top",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50071076507",
      "ndc_label_name": "Easy Comfort Lancets Twist Top",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000163",
      "ndc_label_name": "Easy Comfort Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60006037787",
      "ndc_label_name": "Easy Comfort Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000170",
      "ndc_label_name": "Easy Comfort Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50071076505",
      "ndc_label_name": "Easy Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60006037786",
      "ndc_label_name": "Easy Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000177",
      "ndc_label_name": "Easy Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53681000719",
      "ndc_label_name": "Easy Flow 300 MM Hose",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000720",
      "ndc_label_name": "Easy Flow 400 MM Hose",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000721",
      "ndc_label_name": "Easy Flow Air Nozzle",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000724",
      "ndc_label_name": "Easy Flow Black/Blue Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000701",
      "ndc_label_name": "Easy Flow Black/Orange Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000709",
      "ndc_label_name": "Easy Flow Black/Red Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000704",
      "ndc_label_name": "Easy Flow Black/White Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000707",
      "ndc_label_name": "Easy Flow Black/Yellow Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000705",
      "ndc_label_name": "Easy Flow HEPA Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000711",
      "ndc_label_name": "Easy Flow HEPA Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000702",
      "ndc_label_name": "Easy Flow White/Blue Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000703",
      "ndc_label_name": "Easy Flow White/Green Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000700",
      "ndc_label_name": "Easy Flow White/Pink Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000725",
      "ndc_label_name": "Easy Flow White/White Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000708",
      "ndc_label_name": "Easy Flow White/Yellow Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47884017425",
      "ndc_label_name": "Easy Max Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000117",
      "ndc_label_name": "Easy Mini Eject Lancing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000105",
      "ndc_label_name": "Easy Mini Lancing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50058086418",
      "ndc_label_name": "Easy Neb Nebulizer Filters",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000168",
      "ndc_label_name": "Easy Plus II Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000167",
      "ndc_label_name": "Easy Plus II Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000164",
      "ndc_label_name": "Easy Plus II Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000123",
      "ndc_label_name": "Easy Step Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000122",
      "ndc_label_name": "Easy Step Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000120",
      "ndc_label_name": "Easy Step Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000119",
      "ndc_label_name": "Easy Step Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000148",
      "ndc_label_name": "Easy Talk Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000152",
      "ndc_label_name": "Easy Talk Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000149",
      "ndc_label_name": "Easy Talk Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000150",
      "ndc_label_name": "Easy Talk Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049431",
      "ndc_label_name": "Easy Talk Plus II Control Solution High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049430",
      "ndc_label_name": "Easy Talk Plus II Control Solution Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049422",
      "ndc_label_name": "Easy Talk Plus II Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42423027103",
      "ndc_label_name": "Easy Touch Alcohol Prep Medium PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42423027101",
      "ndc_label_name": "Easy Touch Alcohol Prep Medium PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42423027001",
      "ndc_label_name": "Easy Touch Alcohol Prep Medium PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42423027002",
      "ndc_label_name": "Easy Touch Alcohol Prep Medium PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42423027104",
      "ndc_label_name": "Easy Touch Alcohol Prep Medium PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42423027102",
      "ndc_label_name": "Easy Touch Alcohol Prep Medium PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496081001",
      "ndc_label_name": "Easy Touch Control High & Low SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496023301",
      "ndc_label_name": "Easy Touch FlipLock Insulin Sy 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496023401",
      "ndc_label_name": "Easy Touch FlipLock Insulin Sy 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496023601",
      "ndc_label_name": "Easy Touch FlipLock Insulin Sy 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496009501",
      "ndc_label_name": "Easy Touch Fluringe 25G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496036401",
      "ndc_label_name": "Easy Touch Fluringe SheathLock 25G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090623400",
      "ndc_label_name": "Easy Touch HealthPro Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496700201",
      "ndc_label_name": "Easy Touch HealthPro Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496700401",
      "ndc_label_name": "Easy Touch HealthPro High/Low Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090637500",
      "ndc_label_name": "Easy Touch HealthPro High/Low Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496016401",
      "ndc_label_name": "Easy Touch Insulin Barrels U-100 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496015401",
      "ndc_label_name": "Easy Touch Insulin Barrels U-100 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496011601",
      "ndc_label_name": "Easy Touch Insulin Safety Syr 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496791501",
      "ndc_label_name": "Easy Touch Insulin Safety Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496011701",
      "ndc_label_name": "Easy Touch Insulin Safety Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496011901",
      "ndc_label_name": "Easy Touch Insulin Safety Syr 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496801501",
      "ndc_label_name": "Easy Touch Insulin Safety Syr 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496011801",
      "ndc_label_name": "Easy Touch Insulin Safety Syr 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496651001",
      "ndc_label_name": "Easy Touch Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496271501",
      "ndc_label_name": "Easy Touch Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496271511",
      "ndc_label_name": "Easy Touch Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496702001",
      "ndc_label_name": "Easy Touch Insulin Syringe 27G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496285501",
      "ndc_label_name": "Easy Touch Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496652101",
      "ndc_label_name": "Easy Touch Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496285511",
      "ndc_label_name": "Easy Touch Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496281511",
      "ndc_label_name": "Easy Touch Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496281501",
      "ndc_label_name": "Easy Touch Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496651101",
      "ndc_label_name": "Easy Touch Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496295501",
      "ndc_label_name": "Easy Touch Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496295511",
      "ndc_label_name": "Easy Touch Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496652201",
      "ndc_label_name": "Easy Touch Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496291501",
      "ndc_label_name": "Easy Touch Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496651201",
      "ndc_label_name": "Easy Touch Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496291511",
      "ndc_label_name": "Easy Touch Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496303501",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496303511",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496305511",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496305501",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496301511",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496301501",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496305611",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496305601",
      "ndc_label_name": "Easy Touch Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496313601",
      "ndc_label_name": "Easy Touch Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496313611",
      "ndc_label_name": "Easy Touch Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496315601",
      "ndc_label_name": "Easy Touch Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496315611",
      "ndc_label_name": "Easy Touch Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496311601",
      "ndc_label_name": "Easy Touch Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496311611",
      "ndc_label_name": "Easy Touch Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496212401",
      "ndc_label_name": "Easy Touch Lancets 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496232201",
      "ndc_label_name": "Easy Touch Lancets 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496260801",
      "ndc_label_name": "Easy Touch Lancets 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496261201",
      "ndc_label_name": "Easy Touch Lancets 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496280801",
      "ndc_label_name": "Easy Touch Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496281201",
      "ndc_label_name": "Easy Touch Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496281001",
      "ndc_label_name": "Easy Touch Lancets 28G/Twist",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496300601",
      "ndc_label_name": "Easy Touch Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496305801",
      "ndc_label_name": "Easy Touch Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496301201",
      "ndc_label_name": "Easy Touch Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496301001",
      "ndc_label_name": "Easy Touch Lancets 30G/Twist",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496320601",
      "ndc_label_name": "Easy Touch Lancets 32G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496321201",
      "ndc_label_name": "Easy Touch Lancets 32G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496321001",
      "ndc_label_name": "Easy Touch Lancets 32G/Twist",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496331001",
      "ndc_label_name": "Easy Touch Lancets 33G/Twist",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496702101",
      "ndc_label_name": "Easy Touch Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496080801",
      "ndc_label_name": "Easy Touch Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496300301",
      "ndc_label_name": "Easy Touch Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496310305",
      "ndc_label_name": "Easy Touch Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496310101",
      "ndc_label_name": "Easy Touch Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496310601",
      "ndc_label_name": "Easy Touch Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496310605",
      "ndc_label_name": "Easy Touch Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496320805",
      "ndc_label_name": "Easy Touch Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496320801",
      "ndc_label_name": "Easy Touch Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496320405",
      "ndc_label_name": "Easy Touch Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496320401",
      "ndc_label_name": "Easy Touch Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496212201",
      "ndc_label_name": "Easy Touch Safety Lancets 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496231801",
      "ndc_label_name": "Easy Touch Safety Lancets 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496265801",
      "ndc_label_name": "Easy Touch Safety Lancets 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496261801",
      "ndc_label_name": "Easy Touch Safety Lancets 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496281801",
      "ndc_label_name": "Easy Touch Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496285801",
      "ndc_label_name": "Easy Touch Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496010101",
      "ndc_label_name": "Easy Touch Safety Syringe 25G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496038801",
      "ndc_label_name": "Easy Touch SheathLock Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496038901",
      "ndc_label_name": "Easy Touch SheathLock Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496039001",
      "ndc_label_name": "Easy Touch SheathLock Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496080705",
      "ndc_label_name": "Easy Touch Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090623000",
      "ndc_label_name": "Easy Touch Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000142",
      "ndc_label_name": "Easy Trak Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000145",
      "ndc_label_name": "Easy Trak Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000146",
      "ndc_label_name": "Easy Trak Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "91237000143",
      "ndc_label_name": "Easy Trak Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000738",
      "ndc_label_name": "Easy Trak II Control Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000737",
      "ndc_label_name": "Easy Trak II Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463020350",
      "ndc_label_name": "EasyGluco STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47884017640",
      "ndc_label_name": "EasyMax 15 Level 2 Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47884017644",
      "ndc_label_name": "EasyMax 15 Level 2-3 Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47884017615",
      "ndc_label_name": "EasyMax 15 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47884017544",
      "ndc_label_name": "EasyMax Control Normal/High Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47884017540",
      "ndc_label_name": "EasyMax Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47884017550",
      "ndc_label_name": "EASYMax Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47884017525",
      "ndc_label_name": "EASYMax Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08480490050",
      "ndc_label_name": "EasyPRO Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08480492050",
      "ndc_label_name": "EasyPRO Plus STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490067822",
      "ndc_label_name": "eBase Controller Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72903085301",
      "ndc_label_name": "Elahere Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754100703",
      "ndc_label_name": "Elcys Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754100701",
      "ndc_label_name": "Elcys Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08522000070",
      "ndc_label_name": "Element Compact Control 2 SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08522000071",
      "ndc_label_name": "Element Compact Control 3 SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08522000068",
      "ndc_label_name": "Element Compact Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08522000026",
      "ndc_label_name": "Element Control Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08522000025",
      "ndc_label_name": "Element Control Liquid Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08522000024",
      "ndc_label_name": "Element Control Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08522000023",
      "ndc_label_name": "Element Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00024515010",
      "ndc_label_name": "Elitek SOLUTION RECONSTITUTED 1.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024515175",
      "ndc_label_name": "Elitek SOLUTION RECONSTITUTED 7.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024515174",
      "ndc_label_name": "Elitek Solution Reconstituted 7.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009509310",
      "ndc_label_name": "Ellence Solution 200 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009509301",
      "ndc_label_name": "Ellence Solution 200 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009509125",
      "ndc_label_name": "Ellence Solution 50 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009509101",
      "ndc_label_name": "Ellence Solution 50 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069252202",
      "ndc_label_name": "Elrexfio Solution 44 MG/1.1ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069252201",
      "ndc_label_name": "Elrexfio Solution 44 MG/1.1ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069449401",
      "ndc_label_name": "Elrexfio Solution 76 MG/1.9ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069449402",
      "ndc_label_name": "Elrexfio Solution 76 MG/1.9ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72187040101",
      "ndc_label_name": "Elzonris Solution 1000 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83017951503",
      "ndc_label_name": "Embecta AutoShield Duo 30G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017491003",
      "ndc_label_name": "Embecta Ins Syr U/F 1/2 Unit 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017491001",
      "ndc_label_name": "Embecta Ins Syr U/F 1/2 Unit 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017844003",
      "ndc_label_name": "Embecta Ins Syr U/F 1/2 Unit 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017844001",
      "ndc_label_name": "Embecta Ins Syr U/F 1/2 Unit 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017828003",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017843103",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017843101",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017827903",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017846603",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017846601",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017841103",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017841101",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017827803",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 30G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017490903",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017490603",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017490901",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017491103",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017844703",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017490703",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017491101",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017491201",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017490803",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017491203",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 15/64\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017843801",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017843803",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017829103",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017846801",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017829003",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017846803",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017828903",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017841803",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017841801",
      "ndc_label_name": "Embecta Insulin Syr Ultrafine 31G X 5/16\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017946103",
      "ndc_label_name": "Embecta Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83017946503",
      "ndc_label_name": "Embecta Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83017942003",
      "ndc_label_name": "Embecta Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83017941003",
      "ndc_label_name": "Embecta Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83017942403",
      "ndc_label_name": "Embecta Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017941203",
      "ndc_label_name": "Embecta Insulin Syringe U-100 27G X 5/8\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83017673003",
      "ndc_label_name": "Embecta Insulin Syringe U-500 31G X 6MM 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83017948101",
      "ndc_label_name": "Embecta Pen Needle Nano 2 Gen 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017057403",
      "ndc_label_name": "Embecta Pen Needle Nano 2 Gen 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017055003",
      "ndc_label_name": "Embecta Pen Needle Nano 2 Gen 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017012203",
      "ndc_label_name": "Embecta Pen Needle Nano 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017088303",
      "ndc_label_name": "Embecta Pen Needle Nano 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017820303",
      "ndc_label_name": "Embecta Pen Needle Ultrafine 29G X 12.7MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017088003",
      "ndc_label_name": "Embecta Pen Needle Ultrafine 29G X 12.7MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017088203",
      "ndc_label_name": "Embecta Pen Needle Ultrafine 31G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017011903",
      "ndc_label_name": "Embecta Pen Needle Ultrafine 31G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017010903",
      "ndc_label_name": "Embecta Pen Needle Ultrafine 31G X 8 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017088103",
      "ndc_label_name": "Embecta Pen Needle Ultrafine 31G X 8 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83017074903",
      "ndc_label_name": "Embecta Pen Needle Ultrafine 32G X 6 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000221",
      "ndc_label_name": "Embrace Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000202",
      "ndc_label_name": "Embrace Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000233",
      "ndc_label_name": "Embrace Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000207",
      "ndc_label_name": "Embrace Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000235",
      "ndc_label_name": "Embrace Evo Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000234",
      "ndc_label_name": "Embrace Evo Control Level 1 Liquid Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000206",
      "ndc_label_name": "Embrace Glucose Control Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000204",
      "ndc_label_name": "Embrace Lancets Ultra Thin 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000268",
      "ndc_label_name": "Embrace Lancing Device/Ejector",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000252",
      "ndc_label_name": "Embrace Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000211",
      "ndc_label_name": "Embrace Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000212",
      "ndc_label_name": "Embrace Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000213",
      "ndc_label_name": "Embrace Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000251",
      "ndc_label_name": "Embrace Pressure Activated 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000266",
      "ndc_label_name": "Embrace Pressure Activated 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000241",
      "ndc_label_name": "Embrace Pro Glucose Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000240",
      "ndc_label_name": "Embrace Pro Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000299",
      "ndc_label_name": "Embrace Pro Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000286",
      "ndc_label_name": "Embrace Talk Glucose Control Solution High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000287",
      "ndc_label_name": "Embrace Talk Glucose Control Solution Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000270",
      "ndc_label_name": "Embrace Talk Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000272",
      "ndc_label_name": "Embrace Talk Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000271",
      "ndc_label_name": "Embrace Talk Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000291",
      "ndc_label_name": "Embrace Talk Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000294",
      "ndc_label_name": "Embrace Talk Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11822089766",
      "ndc_label_name": "Embrace Wave Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000224",
      "ndc_label_name": "Embrace Wave Glucose Control Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "14789025007",
      "ndc_label_name": "Emerphed Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789025010",
      "ndc_label_name": "Emerphed Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789025110",
      "ndc_label_name": "Emerphed Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789025109",
      "ndc_label_name": "Emerphed Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789025209",
      "ndc_label_name": "Emerphed Solution Prefilled Syringe 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789025210",
      "ndc_label_name": "Emerphed Solution Prefilled Syringe 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003229111",
      "ndc_label_name": "Empliciti Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003452211",
      "ndc_label_name": "Empliciti Solution Reconstituted 400 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074105501",
      "ndc_label_name": "Emrelis Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074104401",
      "ndc_label_name": "Emrelis Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50486022112",
      "ndc_label_name": "Encare SUPPOSITORY 100 MG VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58160082101",
      "ndc_label_name": "Engerix-B Suspension 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082111",
      "ndc_label_name": "Engerix-B Suspension 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160085905",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 10 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160085927",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 10 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082043",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 10 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082052",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 10 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160085935",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 10 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090122300",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160086135",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569623200",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082151",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082143",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569540800",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569623201",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090122301",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082152",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160086126",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597040601",
      "ndc_label_name": "Enhertu Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76300000805",
      "ndc_label_name": "Enlite Glucose Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419032015",
      "ndc_label_name": "Eovist Solution 0.25 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032005",
      "ndc_label_name": "Eovist Solution 0.25 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219054601",
      "ndc_label_name": "ePHEDrine Sulf (Pressors)+RFID Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219054605",
      "ndc_label_name": "ePHEDrine Sulf (Pressors)+RFID Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219054810",
      "ndc_label_name": "ePHEDrine Sulf (Pressors)+RFID Solution Prefilled Syringe 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219054801",
      "ndc_label_name": "ePHEDrine Sulf (Pressors)+RFID Solution Prefilled Syringe 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023024301",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023024399",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714003710",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478041510",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641623825",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641623801",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781326971",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781326995",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478041501",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023021601",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150037301",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121163705",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714003725",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021083601",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598072511",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478095510",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478051701",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069081901",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145015801",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700024925",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121163707",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023021625",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219025700",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069081910",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023021683",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023021689",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219025701",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572015110",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700024923",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150037325",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572015001",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061125",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598072525",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145015825",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061182",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020301",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020325",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572015010",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572015101",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020310",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266902601",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641623610",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641623601",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374090105",
      "ndc_label_name": "ePHEDrine Sulfate (Pressors) Solution Prefilled Syringe 25 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338002420",
      "ndc_label_name": "EPINEPHrine Bitartrate-NaCl Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090303901",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090303902",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010301",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010310",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462093310",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462093301",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069602",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066080102",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066080301",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517117101",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143947601",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517117110",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298030507",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143947625",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069830",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288060001",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066080101",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517303001",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462076010",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066080325",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572023801",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288011901",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121166002",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329906000",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329906100",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288012001",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288011925",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288015201",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069625",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462076130",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409493305",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409493310",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409493311",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409493301",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090703700",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329331801",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092154305",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 2-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004062340",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154081215",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004061340",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004060840",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004062840",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70324005201",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154081315",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71506006058",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004062740",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004060740",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154081415",
      "ndc_label_name": "EPINEPHrine-NaCl Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82705000201",
      "ndc_label_name": "Epkinly Solution 4 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82705001001",
      "ndc_label_name": "Epkinly Solution 48 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703198501",
      "ndc_label_name": "Epoprostenol Sodium Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756005940",
      "ndc_label_name": "Epoprostenol Sodium Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058710",
      "ndc_label_name": "Epoprostenol Sodium Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058810",
      "ndc_label_name": "Epoprostenol Sodium Solution Reconstituted 1.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703199501",
      "ndc_label_name": "Epoprostenol Sodium Solution Reconstituted 1.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756006040",
      "ndc_label_name": "Epoprostenol Sodium Solution Reconstituted 1.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150021910",
      "ndc_label_name": "Eptifibatide SOLUTION 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021040910",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436002680",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729026003",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436016280",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457062910",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860030310",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121100201",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078002510",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288041210",
      "ndc_label_name": "Eptifibatide Solution 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150022099",
      "ndc_label_name": "Eptifibatide SOLUTION 200 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729026038",
      "ndc_label_name": "Eptifibatide Solution 200 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078002710",
      "ndc_label_name": "Eptifibatide Solution 200 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457063010",
      "ndc_label_name": "Eptifibatide Solution 200 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338955810",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457063110",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150021899",
      "ndc_label_name": "Eptifibatide SOLUTION 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121100301",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436002780",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729025938",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860030551",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021040851",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288041351",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436016380",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078002610",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634030151",
      "ndc_label_name": "Eptifibatide Solution 75 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49035038600",
      "ndc_label_name": "EQ Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131010486",
      "ndc_label_name": "EQ Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131024071",
      "ndc_label_name": "EQ Space Chamber Anti-Static Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81131024070",
      "ndc_label_name": "EQ Space Chamber Anti-Static L Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81131024069",
      "ndc_label_name": "EQ Space Chamber Anti-Static M Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81131024068",
      "ndc_label_name": "EQ Space Chamber Anti-Static S Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "41163081630",
      "ndc_label_name": "EQL Alcohol Swabs PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66733094823",
      "ndc_label_name": "Erbitux Solution 100 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66733095823",
      "ndc_label_name": "Erbitux Solution 200 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781339194",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065641",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143916701",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019008001",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822208001",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462077020",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298389001",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598012511",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628900",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095008001",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603036801",
      "ndc_label_name": "eriBULin Mesylate Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143942910",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019966",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939801",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714088910",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143942901",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598090158",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409351021",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409351022",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150028220",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567082001",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939810",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023022110",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714088901",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505619604",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023022101",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023022185",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019920",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567082010",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082320",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505619600",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023022189",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001040831",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266015901",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150028209",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598090111",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001040829",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082301",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266015905",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266015910",
      "ndc_label_name": "Ertapenem Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931110",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044512",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155016042",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950701",
      "ndc_label_name": "Etomidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931001",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044522",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150022220",
      "ndc_label_name": "Etomidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950601",
      "ndc_label_name": "Etomidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950610",
      "ndc_label_name": "Etomidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457090320",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014610",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155016032",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931010",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014710",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044501",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044510",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950710",
      "ndc_label_name": "Etomidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382054507",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457090300",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067410",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931101",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014601",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572016001",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044702",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155016031",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485050910",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572016101",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044720",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150022110",
      "ndc_label_name": "Etomidate SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572016010",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155016041",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457090200",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382054508",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457090210",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067420",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014701",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485050810",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485050801",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485050901",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572016110",
      "ndc_label_name": "Etomidate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61269041020",
      "ndc_label_name": "Etopophos Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143951201",
      "ndc_label_name": "Etoposide SOLUTION 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729011411",
      "ndc_label_name": "Etoposide SOLUTION 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026524",
      "ndc_label_name": "Etoposide SOLUTION 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010450",
      "ndc_label_name": "Etoposide SOLUTION 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017750",
      "ndc_label_name": "Etoposide Solution 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026527",
      "ndc_label_name": "Etoposide SOLUTION 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001068327",
      "ndc_label_name": "Etoposide Solution 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729011431",
      "ndc_label_name": "Etoposide SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026525",
      "ndc_label_name": "Etoposide SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010405",
      "ndc_label_name": "Etoposide Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143937601",
      "ndc_label_name": "Etoposide Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017505",
      "ndc_label_name": "Etoposide Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026522",
      "ndc_label_name": "Etoposide SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143951001",
      "ndc_label_name": "Etoposide SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010406",
      "ndc_label_name": "Etoposide Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017625",
      "ndc_label_name": "Etoposide Solution 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143951101",
      "ndc_label_name": "Etoposide SOLUTION 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026523",
      "ndc_label_name": "Etoposide Solution 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001068226",
      "ndc_label_name": "Etoposide Solution 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729011408",
      "ndc_label_name": "Etoposide SOLUTION 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010425",
      "ndc_label_name": "Etoposide SOLUTION 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026526",
      "ndc_label_name": "Etoposide Solution 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505642300",
      "ndc_label_name": "Evdi Solution 1 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17491002429",
      "ndc_label_name": "Eversense 365 Sensor/Holder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17491002424",
      "ndc_label_name": "Eversense 365 Smart Transmit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17491002235",
      "ndc_label_name": "Eversense Sensor/Holder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08522000017",
      "ndc_label_name": "Evolution Autocode STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08522000018",
      "ndc_label_name": "Evolution Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72893000101",
      "ndc_label_name": "Evomela Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66977000603",
      "ndc_label_name": "Excel-Gel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66977002601",
      "ndc_label_name": "Excel-Gel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66977000601",
      "ndc_label_name": "Excel-Gel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65250013304",
      "ndc_label_name": "Exparel SUSPENSION 1.3 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65250026604",
      "ndc_label_name": "Exparel SUSPENSION 1.3 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65250013309",
      "ndc_label_name": "Exparel SUSPENSION 1.3 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65250026609",
      "ndc_label_name": "Exparel SUSPENSION 1.3 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755005051",
      "ndc_label_name": "Eylea HD Solution 8 MG/0.07ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755005001",
      "ndc_label_name": "Eylea HD Solution 8 MG/0.07ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755000555",
      "ndc_label_name": "Eylea Solution 2 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755000502",
      "ndc_label_name": "Eylea SOLUTION 2 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755000554",
      "ndc_label_name": "Eylea Solution Prefilled Syringe 2 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755000501",
      "ndc_label_name": "Eylea Solution Prefilled Syringe 2 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "05632086800",
      "ndc_label_name": "Fantasy Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632086805",
      "ndc_label_name": "Fantasy Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632086820",
      "ndc_label_name": "Fantasy Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632086825",
      "ndc_label_name": "Fantasy Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632086810",
      "ndc_label_name": "Fantasy Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632086830",
      "ndc_label_name": "Fantasy Lubricated/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632086815",
      "ndc_label_name": "Fantasy Lubricated/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632086835",
      "ndc_label_name": "Fantasy Lubricated/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00310072010",
      "ndc_label_name": "Faslodex Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831016410",
      "ndc_label_name": "Favlyxa Solution 2.5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831014301",
      "ndc_label_name": "Favlyxa Solution 250 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61783000012",
      "ndc_label_name": "FC2 Female Condom",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08454000122",
      "ndc_label_name": "FemCap DEVICE 22 MM VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08454000226",
      "ndc_label_name": "FemCap DEVICE 26 MM VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08454000330",
      "ndc_label_name": "FemCap DEVICE 30 MM VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572017025",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909337",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602725",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 100 MCG/2ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909332",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909422",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 100 MCG/2ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602401",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909412",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 100 MCG/2ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602701",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 100 MCG/2ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080612",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602410",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478003002",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81565020501",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080602",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572017001",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81565020502",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602601",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 1000 MCG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909416",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 1000 MCG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909431",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 1000 MCG/20ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080614",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 1000 MCG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602605",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 1000 MCG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080620",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 1000 MCG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602901",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 1000 MCG/20ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909418",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080613",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080605",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909425",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 250 MCG/5ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909335",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909345",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602510",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478003005",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602501",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602825",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572017101",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572017125",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602801",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572017110",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602810",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 250 MCG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641603001",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 2500 MCG/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909455",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 2500 MCG/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909444",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 2500 MCG/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909441",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 2500 MCG/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572017201",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 2500 MCG/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080650",
      "ndc_label_name": "FentaNYL Citrate (PF) Solution 2500 MCG/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909461",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 2500 MCG/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624701",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080611",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080601",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624725",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909417",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 500 MCG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409909428",
      "ndc_label_name": "FentaNYL Citrate (PF) SOLUTION 500 MCG/10ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624901",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution Prefilled Syringe 25 MCG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624910",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution Prefilled Syringe 25 MCG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624810",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution Prefilled Syringe 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080811",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution Prefilled Syringe 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624801",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution Prefilled Syringe 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323080801",
      "ndc_label_name": "fentaNYL Citrate (PF) Solution Prefilled Syringe 50 MCG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63037019025",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004020006",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081000",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449001305",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081720",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081701",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081020",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73702020432",
      "ndc_label_name": "fentaNYL Citrate Solution Prefilled Syringe 100 MCG/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982035081",
      "ndc_label_name": "Fibryga Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982035001",
      "ndc_label_name": "Fibryga Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982034701",
      "ndc_label_name": "Fibryga SOLUTION RECONSTITUTED Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982034981",
      "ndc_label_name": "Fibryga Solution Reconstituted Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982034801",
      "ndc_label_name": "Fibryga SOLUTION RECONSTITUTED Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982034901",
      "ndc_label_name": "Fibryga Solution Reconstituted Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08521080100",
      "ndc_label_name": "Fifty50 Alcohol Prep PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "92896000009",
      "ndc_label_name": "Fifty50 Glucose Test 2.0 STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08521500531",
      "ndc_label_name": "Fifty50 Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521550531",
      "ndc_label_name": "Fifty50 Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521550831",
      "ndc_label_name": "Fifty50 Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521500831",
      "ndc_label_name": "Fifty50 Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521500432",
      "ndc_label_name": "Fifty50 Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521550432",
      "ndc_label_name": "Fifty50 Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521500632",
      "ndc_label_name": "Fifty50 Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521550632",
      "ndc_label_name": "Fifty50 Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521081030",
      "ndc_label_name": "Fifty50 Safety Seal Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08521081032",
      "ndc_label_name": "Fifty50 Safety Seal Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08521000331",
      "ndc_label_name": "Fifty50 Superior Comfort Syr 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08521000231",
      "ndc_label_name": "Fifty50 Superior Comfort Syr 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521000131",
      "ndc_label_name": "Fifty50 Superior Comfort Syr 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08521081033",
      "ndc_label_name": "Fifty50 Unilet Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490041058",
      "ndc_label_name": "Filter Air PP",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00193596531",
      "ndc_label_name": "Fingerstix Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55566840301",
      "ndc_label_name": "Firmagon (240 MG Dose) Solution Reconstituted 120 MG/VIAL Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55566830301",
      "ndc_label_name": "Firmagon SOLUTION RECONSTITUTED 80 MG Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953000404",
      "ndc_label_name": "Flebogamma DIF SOLUTION 10 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953000409",
      "ndc_label_name": "Flebogamma DIF SOLUTION 10 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953000405",
      "ndc_label_name": "Flebogamma DIF SOLUTION 20 GM/400ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953000400",
      "ndc_label_name": "Flebogamma DIF SOLUTION 20 GM/400ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953000403",
      "ndc_label_name": "Flebogamma DIF SOLUTION 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953000408",
      "ndc_label_name": "Flebogamma DIF SOLUTION 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944049301",
      "ndc_label_name": "Flexbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944049304",
      "ndc_label_name": "Flexbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944049303",
      "ndc_label_name": "Flexbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944049302",
      "ndc_label_name": "Flexbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944049506",
      "ndc_label_name": "Flexbumin Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944049505",
      "ndc_label_name": "Flexbumin Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23594090101",
      "ndc_label_name": "Flexichamber DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461002504",
      "ndc_label_name": "Fluad Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461002403",
      "ndc_label_name": "Fluad Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461002604",
      "ndc_label_name": "Fluad Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461002404",
      "ndc_label_name": "Fluad Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461002503",
      "ndc_label_name": "Fluad Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461002603",
      "ndc_label_name": "Fluad Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58160072541",
      "ndc_label_name": "Fluarix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160091241",
      "ndc_label_name": "Fluarix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160072552",
      "ndc_label_name": "Fluarix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160088452",
      "ndc_label_name": "Fluarix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160088441",
      "ndc_label_name": "Fluarix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160091252",
      "ndc_label_name": "Fluarix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281072610",
      "ndc_label_name": "Flublok Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281072510",
      "ndc_label_name": "Flublok Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281072688",
      "ndc_label_name": "Flublok Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281072410",
      "ndc_label_name": "Flublok Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281072588",
      "ndc_label_name": "Flublok Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281072488",
      "ndc_label_name": "Flublok Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461065404",
      "ndc_label_name": "Flucelvax Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461065403",
      "ndc_label_name": "Flucelvax Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461065504",
      "ndc_label_name": "Flucelvax Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461065603",
      "ndc_label_name": "Flucelvax Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461065503",
      "ndc_label_name": "Flucelvax Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70461065604",
      "ndc_label_name": "Flucelvax Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963062151",
      "ndc_label_name": "Fludarabine Phosphate Solution 50 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021024202",
      "ndc_label_name": "Fludarabine Phosphate SOLUTION 50 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923060402",
      "ndc_label_name": "Fludarabine Phosphate Solution 50 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323019202",
      "ndc_label_name": "Fludarabine Phosphate SOLUTION 50 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963060955",
      "ndc_label_name": "Fludarabine Phosphate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24201023701",
      "ndc_label_name": "Fludarabine Phosphate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515090441",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515082241",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515090452",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515081041",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515081052",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515082252",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019011351",
      "ndc_label_name": "FluMist Liquid Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019011210",
      "ndc_label_name": "FluMist Liquid Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019031100",
      "ndc_label_name": "FluMist Liquid Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019011200",
      "ndc_label_name": "FluMist Liquid Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019011310",
      "ndc_label_name": "FluMist Liquid Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019011251",
      "ndc_label_name": "FluMist Liquid Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019031110",
      "ndc_label_name": "FluMist Liquid Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208039183",
      "ndc_label_name": "Fluor-I-Strips A.T. Strip 1 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789012305",
      "ndc_label_name": "Fluorescein Sodium Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789012307",
      "ndc_label_name": "Fluorescein Sodium Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83851010030",
      "ndc_label_name": "Fluorescein Sodium Strip 1 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82260073405",
      "ndc_label_name": "Fluorescein Sodium/Benoxinate Solution 0.3-0.4 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682073205",
      "ndc_label_name": "Fluorescein Sodium/Benoxinate Solution 0.3-0.4 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065009265",
      "ndc_label_name": "Fluorescite Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026629",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011701",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011741",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027667",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011728",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011720",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026631",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027605",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052431",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700018723",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052429",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700018722",
      "ndc_label_name": "Fluorouracil Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027611",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011759",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021021598",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052527",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150049801",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332075150",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011758",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026624",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011751",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026627",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700018822",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001062727",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017075",
      "ndc_label_name": "Fluorouracil Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011769",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021021599",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700018922",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011768",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027638",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332077931",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001062832",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150049901",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052532",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011761",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288015476",
      "ndc_label_name": "Fluorouracil Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011719",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027668",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011718",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027603",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700018622",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011710",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052430",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011731",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011700",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052428",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011743",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700018623",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026628",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001026630",
      "ndc_label_name": "Fluorouracil Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281012688",
      "ndc_label_name": "Fluzone High-Dose Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281012488",
      "ndc_label_name": "Fluzone High-Dose Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281012465",
      "ndc_label_name": "Fluzone High-Dose Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281012665",
      "ndc_label_name": "Fluzone High-Dose Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281012565",
      "ndc_label_name": "Fluzone High-Dose Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281012588",
      "ndc_label_name": "Fluzone High-Dose Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281064178",
      "ndc_label_name": "Fluzone Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281064115",
      "ndc_label_name": "Fluzone Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281064515",
      "ndc_label_name": "Fluzone Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281064315",
      "ndc_label_name": "Fluzone Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281064378",
      "ndc_label_name": "Fluzone Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281064578",
      "ndc_label_name": "Fluzone Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281042450",
      "ndc_label_name": "Fluzone Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281042650",
      "ndc_label_name": "Fluzone Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281042550",
      "ndc_label_name": "Fluzone Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281042488",
      "ndc_label_name": "Fluzone Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281042688",
      "ndc_label_name": "Fluzone Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281042588",
      "ndc_label_name": "Fluzone Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69112000017",
      "ndc_label_name": "Flyp HypersoniQ Cartridge",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00407878701",
      "ndc_label_name": "Flyrcado Solution 5-55 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48818000101",
      "ndc_label_name": "Folotyn Solution 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72893000301",
      "ndc_label_name": "Folotyn Solution 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72893000501",
      "ndc_label_name": "Folotyn Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48818000102",
      "ndc_label_name": "Folotyn Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50070097934",
      "ndc_label_name": "FondCircle Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50070097936",
      "ndc_label_name": "FondCircle Control Solution Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50070097943",
      "ndc_label_name": "FondCircle Electronic Peak Flo Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50070097932",
      "ndc_label_name": "FondCircle Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50070097933",
      "ndc_label_name": "FondCircle Single Use Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001307",
      "ndc_label_name": "Fora 6 Connect Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001311",
      "ndc_label_name": "Fora 6 Connect/GTel Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98939000204",
      "ndc_label_name": "FORA Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98939000205",
      "ndc_label_name": "FORA Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16042001199",
      "ndc_label_name": "FORA Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98939000206",
      "ndc_label_name": "FORA Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16042001200",
      "ndc_label_name": "FORA Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16042001166",
      "ndc_label_name": "Fora D40/G31 Blood Glucose STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98939000234",
      "ndc_label_name": "FORA G20 Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001024",
      "ndc_label_name": "FORA G20 Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001018",
      "ndc_label_name": "Fora GD20 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001122",
      "ndc_label_name": "FORA GD50 Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001339",
      "ndc_label_name": "FORA GTel Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98939000261",
      "ndc_label_name": "FORA Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001201",
      "ndc_label_name": "FORA Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001203",
      "ndc_label_name": "FORA Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98939000258",
      "ndc_label_name": "FORA Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001366",
      "ndc_label_name": "FORA TN'G Advance Pro Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001365",
      "ndc_label_name": "FORA TN'G Advance Pro Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001198",
      "ndc_label_name": "Fora TN'G/TN'G Voice STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98939000236",
      "ndc_label_name": "FORA V10 Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001020",
      "ndc_label_name": "FORA V10 Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001040",
      "ndc_label_name": "FORA V30a Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001026",
      "ndc_label_name": "FORA V30a Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98939000260",
      "ndc_label_name": "FORA V30a Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001055",
      "ndc_label_name": "ForaCare GD40 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98939000242",
      "ndc_label_name": "ForaCare GDH Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98939000240",
      "ndc_label_name": "ForaCare GDH Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98939000241",
      "ndc_label_name": "ForaCare GDH Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16042001059",
      "ndc_label_name": "ForaCare premium V10 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001088",
      "ndc_label_name": "ForaCare Test N Go Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10019036040",
      "ndc_label_name": "Forane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019036060",
      "ndc_label_name": "Forane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "99073014002",
      "ndc_label_name": "FreeStyle Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "99073070432",
      "ndc_label_name": "FreeStyle Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "99073071227",
      "ndc_label_name": "FreeStyle InsuLinx Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073071230",
      "ndc_label_name": "FreeStyle InsuLinx Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073013001",
      "ndc_label_name": "FreeStyle Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599000200",
      "ndc_label_name": "FreeStyle Libre 14 Day Reader Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599000101",
      "ndc_label_name": "FreeStyle Libre 14 Day Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599083500",
      "ndc_label_name": "FreeStyle Libre 2 Plus Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629200",
      "ndc_label_name": "FreeStyle Libre 2 Reader Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599080300",
      "ndc_label_name": "FreeStyle Libre 2 Reader Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599080000",
      "ndc_label_name": "FreeStyle Libre 2 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629000",
      "ndc_label_name": "FreeStyle Libre 2 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724800",
      "ndc_label_name": "FreeStyle Libre 3 Plus Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599084400",
      "ndc_label_name": "FreeStyle Libre 3 Plus Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710000",
      "ndc_label_name": "FreeStyle Libre 3 Reader Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599082000",
      "ndc_label_name": "FreeStyle Libre 3 Reader Device",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638500",
      "ndc_label_name": "FreeStyle Libre 3 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599081800",
      "ndc_label_name": "FreeStyle Libre 3 Sensor",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "99073070827",
      "ndc_label_name": "FreeStyle Lite Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073070819",
      "ndc_label_name": "FreeStyle Lite Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073071026",
      "ndc_label_name": "FreeStyle Lite Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073070822",
      "ndc_label_name": "FreeStyle Lite Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599157701",
      "ndc_label_name": "FreeStyle Precision Neo Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599157904",
      "ndc_label_name": "FreeStyle Precision Neo Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073070792",
      "ndc_label_name": "FreeStyle Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073042050",
      "ndc_label_name": "FreeStyle Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073012401",
      "ndc_label_name": "FreeStyle Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073012101",
      "ndc_label_name": "FreeStyle Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073012050",
      "ndc_label_name": "FreeStyle Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073012450",
      "ndc_label_name": "FreeStyle Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "99073070428",
      "ndc_label_name": "FreeStyle Unistick II Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "07411089003",
      "ndc_label_name": "Full Kit Nebulizer Set",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143902201",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143902202",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781307912",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591501911",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781353212",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011801",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007001",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591501902",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310772010",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021046274",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781905501",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781905512",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001042485",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150039401",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011802",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781307901",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043631",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462031732",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729043630",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598026202",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001042486",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332065005",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598026211",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781349212",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700028498",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121146301",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021047166",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598026223",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048485",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332065010",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071505",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781353201",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710168808",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121146303",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150039402",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457031100",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710168802",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457031105",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052286",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007002",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462031740",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021174",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121146302",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021047174",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021141",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048486",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288055585",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071501",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634020374",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288055586",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052285",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001062686",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001062685",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603010501",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121146309",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603010502",
      "ndc_label_name": "Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80803015350",
      "ndc_label_name": "Fyarro Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032503",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032507",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032505",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032501",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032508",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032504",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032502",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032519",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032511",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032509",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032513",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032512",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032515",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032514",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032518",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032537",
      "ndc_label_name": "Gadavist Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032528",
      "ndc_label_name": "Gadavist Solution Prefilled Syringe 10 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032526",
      "ndc_label_name": "Gadavist Solution Prefilled Syringe 15 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032529",
      "ndc_label_name": "Gadavist Solution Prefilled Syringe 15 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032522",
      "ndc_label_name": "Gadavist Solution Prefilled Syringe 7.5 MMOL/7.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419032527",
      "ndc_label_name": "Gadavist Solution Prefilled Syringe 7.5 MMOL/7.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028100",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028105",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028107",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028115",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028110",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028730",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028910",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028102",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021280",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028710",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028965",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028103",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021454",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028108",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021254",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021480",
      "ndc_label_name": "Gadobutrol Solution 1 MMOL/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012335",
      "ndc_label_name": "Gadoterate Meglumine Solution 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008620",
      "ndc_label_name": "Gadoterate Meglumine Solution 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008601",
      "ndc_label_name": "Gadoterate Meglumine Solution 10 MMOL/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008001",
      "ndc_label_name": "Gadoterate Meglumine Solution 2.5 MMOL/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012331",
      "ndc_label_name": "Gadoterate Meglumine Solution 2.5 MMOL/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008005",
      "ndc_label_name": "Gadoterate Meglumine Solution 2.5 MMOL/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008210",
      "ndc_label_name": "Gadoterate Meglumine Solution 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008201",
      "ndc_label_name": "Gadoterate Meglumine Solution 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012333",
      "ndc_label_name": "Gadoterate Meglumine Solution 5 MMOL/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008850",
      "ndc_label_name": "Gadoterate Meglumine Solution 50 MMOL/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008806",
      "ndc_label_name": "Gadoterate Meglumine Solution 50 MMOL/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012356",
      "ndc_label_name": "Gadoterate Meglumine Solution 50 MMOL/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012334",
      "ndc_label_name": "Gadoterate Meglumine Solution 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008415",
      "ndc_label_name": "Gadoterate Meglumine Solution 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219008401",
      "ndc_label_name": "Gadoterate Meglumine Solution 7.5 MMOL/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012131",
      "ndc_label_name": "Gadoteridol Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012133",
      "ndc_label_name": "Gadoteridol Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012135",
      "ndc_label_name": "Gadoteridol Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012134",
      "ndc_label_name": "Gadoteridol Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533033513",
      "ndc_label_name": "GamaSTAN Solution Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533033540",
      "ndc_label_name": "GamaSTAN Solution Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533033504",
      "ndc_label_name": "GamaSTAN Solution Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533033512",
      "ndc_label_name": "GamaSTAN Solution Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270501",
      "ndc_label_name": "Gammagard ERC Solution 10 GM/100ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270510",
      "ndc_label_name": "Gammagard ERC Solution 10 GM/100ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270505",
      "ndc_label_name": "Gammagard ERC Solution 5 GM/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270550",
      "ndc_label_name": "Gammagard ERC Solution 5 GM/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944265804",
      "ndc_label_name": "Gammagard S/D Less IgA SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944265603",
      "ndc_label_name": "Gammagard S/D Less IgA SOLUTION RECONSTITUTED 5 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270002",
      "ndc_label_name": "Gammagard SOLUTION 1 GM/10ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270008",
      "ndc_label_name": "Gammagard Solution 1 GM/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270005",
      "ndc_label_name": "Gammagard SOLUTION 10 GM/100ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270011",
      "ndc_label_name": "Gammagard Solution 10 GM/100ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270003",
      "ndc_label_name": "Gammagard SOLUTION 2.5 GM/25ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270009",
      "ndc_label_name": "Gammagard Solution 2.5 GM/25ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270006",
      "ndc_label_name": "Gammagard SOLUTION 20 GM/200ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270012",
      "ndc_label_name": "Gammagard Solution 20 GM/200ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270007",
      "ndc_label_name": "Gammagard SOLUTION 30 GM/300ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270013",
      "ndc_label_name": "Gammagard Solution 30 GM/300ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270004",
      "ndc_label_name": "Gammagard SOLUTION 5 GM/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944270010",
      "ndc_label_name": "Gammagard Solution 5 GM/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125090001",
      "ndc_label_name": "Gammaked Solution 1 GM/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125090010",
      "ndc_label_name": "Gammaked SOLUTION 10 GM/100ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125090011",
      "ndc_label_name": "Gammaked Solution 10 GM/100ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125090021",
      "ndc_label_name": "Gammaked Solution 20 GM/200ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125090020",
      "ndc_label_name": "Gammaked SOLUTION 20 GM/200ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125090050",
      "ndc_label_name": "Gammaked SOLUTION 5 GM/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125090051",
      "ndc_label_name": "Gammaked Solution 5 GM/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823506",
      "ndc_label_name": "Gammaplex SOLUTION 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823502",
      "ndc_label_name": "Gammaplex SOLUTION 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823403",
      "ndc_label_name": "Gammaplex SOLUTION 10 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823407",
      "ndc_label_name": "Gammaplex SOLUTION 10 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823507",
      "ndc_label_name": "Gammaplex SOLUTION 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823503",
      "ndc_label_name": "Gammaplex SOLUTION 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823408",
      "ndc_label_name": "Gammaplex SOLUTION 20 GM/400ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823404",
      "ndc_label_name": "Gammaplex SOLUTION 20 GM/400ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823402",
      "ndc_label_name": "Gammaplex SOLUTION 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823406",
      "ndc_label_name": "Gammaplex SOLUTION 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823501",
      "ndc_label_name": "Gammaplex SOLUTION 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208823505",
      "ndc_label_name": "Gammaplex SOLUTION 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080013",
      "ndc_label_name": "Gamunex-C SOLUTION 1 GM/10ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080012",
      "ndc_label_name": "Gamunex-C SOLUTION 1 GM/10ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080071",
      "ndc_label_name": "Gamunex-C SOLUTION 10 GM/100ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080072",
      "ndc_label_name": "Gamunex-C SOLUTION 10 GM/100ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080015",
      "ndc_label_name": "Gamunex-C SOLUTION 2.5 GM/25ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080016",
      "ndc_label_name": "Gamunex-C SOLUTION 2.5 GM/25ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080025",
      "ndc_label_name": "Gamunex-C SOLUTION 20 GM/200ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080024",
      "ndc_label_name": "Gamunex-C SOLUTION 20 GM/200ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080040",
      "ndc_label_name": "Gamunex-C SOLUTION 40 GM/400ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080041",
      "ndc_label_name": "Gamunex-C SOLUTION 40 GM/400ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080021",
      "ndc_label_name": "Gamunex-C SOLUTION 5 GM/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533080020",
      "ndc_label_name": "Gamunex-C SOLUTION 5 GM/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006411903",
      "ndc_label_name": "Gardasil 9 Suspension 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006411901",
      "ndc_label_name": "Gardasil 9 Suspension 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090244300",
      "ndc_label_name": "Gardasil 9 Suspension 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006412102",
      "ndc_label_name": "Gardasil 9 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006412101",
      "ndc_label_name": "Gardasil 9 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090495800",
      "ndc_label_name": "Gardasil 9 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270044540",
      "ndc_label_name": "Gastrografin Solution 66-10 % Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270044535",
      "ndc_label_name": "Gastrografin Solution 66-10 % Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242007001",
      "ndc_label_name": "Gazyva Solution 1000 MG/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08539810001",
      "ndc_label_name": "GE100 Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539810003",
      "ndc_label_name": "GE100 Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539810000",
      "ndc_label_name": "GE100 Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539810002",
      "ndc_label_name": "GE100 Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539900100",
      "ndc_label_name": "GE100 Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00143934101",
      "ndc_label_name": "Gemcitabine HCl Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457061730",
      "ndc_label_name": "Gemcitabine HCl SOLUTION 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018125",
      "ndc_label_name": "Gemcitabine HCl Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023926",
      "ndc_label_name": "Gemcitabine HCl Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485022210",
      "ndc_label_name": "Gemcitabine HCl Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018101",
      "ndc_label_name": "Gemcitabine HCl Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742049626",
      "ndc_label_name": "Gemcitabine HCl Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011728",
      "ndc_label_name": "Gemcitabine HCl Solution 1 GM/26.3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457061810",
      "ndc_label_name": "Gemcitabine HCl SOLUTION 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742049753",
      "ndc_label_name": "Gemcitabine HCl Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143934201",
      "ndc_label_name": "Gemcitabine HCl Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018201",
      "ndc_label_name": "Gemcitabine HCl Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485022320",
      "ndc_label_name": "Gemcitabine HCl Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023952",
      "ndc_label_name": "Gemcitabine HCl Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018225",
      "ndc_label_name": "Gemcitabine HCl Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011754",
      "ndc_label_name": "Gemcitabine HCl Solution 2 GM/52.6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143934001",
      "ndc_label_name": "Gemcitabine HCl Solution 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742049805",
      "ndc_label_name": "Gemcitabine HCl Solution 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018301",
      "ndc_label_name": "Gemcitabine HCl Solution 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023905",
      "ndc_label_name": "Gemcitabine HCl Solution 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018325",
      "ndc_label_name": "Gemcitabine HCl Solution 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485022102",
      "ndc_label_name": "Gemcitabine HCl Solution 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457061610",
      "ndc_label_name": "Gemcitabine HCl SOLUTION 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011706",
      "ndc_label_name": "Gemcitabine HCl Solution 200 MG/5.26ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023551",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018601",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714093001",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323012553",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111068725",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020550",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729011711",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011450",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023550",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323012594",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729011838",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323012603",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018701",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939401",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011310",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090901",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010294",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409018501",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323010213",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023410",
      "ndc_label_name": "Gemcitabine HCl SOLUTION RECONSTITUTED 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729009203",
      "ndc_label_name": "Gemcitabine HCl Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57629000420",
      "ndc_label_name": "Genteel Butterfly Touch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000409",
      "ndc_label_name": "Genteel Contact Tips (Blue)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000406",
      "ndc_label_name": "Genteel Contact Tips (Clear)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000407",
      "ndc_label_name": "Genteel Contact Tips (Green)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000405",
      "ndc_label_name": "Genteel Contact Tips (Orange)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000419",
      "ndc_label_name": "Genteel Contact Tips (Rainbow)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000404",
      "ndc_label_name": "Genteel Contact Tips (Violet)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000408",
      "ndc_label_name": "Genteel Contact Tips (Yellow)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000421",
      "ndc_label_name": "Genteel Lancing Kit (Blue) Kit",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000410",
      "ndc_label_name": "Genteel Nozzles",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000400",
      "ndc_label_name": "Genteel Plus Lancing (Black)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000418",
      "ndc_label_name": "Genteel Plus Lancing (Purple)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000413",
      "ndc_label_name": "Genteel Plus Lancing (White)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000415",
      "ndc_label_name": "Genteel Plus Lancing Dev(Blue)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57629000412",
      "ndc_label_name": "Genteel Plus Lancing Dev(Pink)",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68906000010",
      "ndc_label_name": "GenUltimate Test STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08626100750",
      "ndc_label_name": "GHT Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68547000501",
      "ndc_label_name": "Giapreza Solution 0.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68547050102",
      "ndc_label_name": "Giapreza SOLUTION 2.5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338005008",
      "ndc_label_name": "Gliadel Wafer WAFER 7.7 MG IMPLANT",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "90166011103",
      "ndc_label_name": "Global Alcohol Prep Ease PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166022203",
      "ndc_label_name": "Global Alcohol Prep Ease PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166063132",
      "ndc_label_name": "Global Ease Inject Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166083152",
      "ndc_label_name": "Global Ease Inject Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166043154",
      "ndc_label_name": "Global Ease Inject Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166031645",
      "ndc_label_name": "Global Easy Glide Insulin Syr 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166023645",
      "ndc_label_name": "Global Easy Glide Insulin Syr 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166013645",
      "ndc_label_name": "Global Easy Glide Insulin Syr 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166025635",
      "ndc_label_name": "Global Easy Glide Insulin Syr 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166043152",
      "ndc_label_name": "Global Easy Glide Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166085055",
      "ndc_label_name": "Global Inject Ease Insulin Syr 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166085015",
      "ndc_label_name": "Global Inject Ease Insulin Syr 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166095035",
      "ndc_label_name": "Global Inject Ease Insulin Syr 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166095055",
      "ndc_label_name": "Global Inject Ease Insulin Syr 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166095015",
      "ndc_label_name": "Global Inject Ease Insulin Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166005035",
      "ndc_label_name": "Global Inject Ease Insulin Syr 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166005055",
      "ndc_label_name": "Global Inject Ease Insulin Syr 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166005015",
      "ndc_label_name": "Global Inject Ease Insulin Syr 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166005655",
      "ndc_label_name": "Global Inject Ease Insulin Syr 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166015635",
      "ndc_label_name": "Global Inject Ease Insulin Syr 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166015655",
      "ndc_label_name": "Global Inject Ease Insulin Syr 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166015615",
      "ndc_label_name": "Global Inject Ease Insulin Syr 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166012804",
      "ndc_label_name": "Global Inject Ease Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166013004",
      "ndc_label_name": "Global Inject Ease Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166045035",
      "ndc_label_name": "Global Insulin Syringes 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "90166012102",
      "ndc_label_name": "Global Lancing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51801000940",
      "ndc_label_name": "GloStrips Strip 1 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63323059403",
      "ndc_label_name": "Glucagon HCl (Diagnostic) SOLUTION RECONSTITUTED 1 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059606",
      "ndc_label_name": "Glucagon HCl (Diagnostic) Solution Reconstituted 1 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059608",
      "ndc_label_name": "Glucagon HCl (Diagnostic) Solution Reconstituted 1 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059303",
      "ndc_label_name": "Glucagon HCl (Diagnostic) SOLUTION RECONSTITUTED 1 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059611",
      "ndc_label_name": "Glucagon HCl (Diagnostic) Solution Reconstituted 1 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059603",
      "ndc_label_name": "Glucagon HCl (Diagnostic) Solution Reconstituted 1 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059616",
      "ndc_label_name": "Glucagon HCl (Diagnostic) SOLUTION RECONSTITUTED 1 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323059613",
      "ndc_label_name": "Glucagon HCl (Diagnostic) SOLUTION RECONSTITUTED 1 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08531388800",
      "ndc_label_name": "Gluco Perfect 3 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317740006",
      "ndc_label_name": "Glucocard 01 Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317720005",
      "ndc_label_name": "Glucocard 01 Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317720050",
      "ndc_label_name": "Glucocard 01 Sensor Plus STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317740050",
      "ndc_label_name": "Glucocard 01 Sensor Plus STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317570005",
      "ndc_label_name": "Glucocard Expression Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317570050",
      "ndc_label_name": "Glucocard Expression Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317572050",
      "ndc_label_name": "Glucocard Expression Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317540005",
      "ndc_label_name": "Glucocard Shine Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317540050",
      "ndc_label_name": "Glucocard Shine Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317760050",
      "ndc_label_name": "Glucocard Vital Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317762050",
      "ndc_label_name": "Glucocard Vital Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317750005",
      "ndc_label_name": "Glucocard X-Sensor Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317752050",
      "ndc_label_name": "Glucocard X-Sensor STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317750050",
      "ndc_label_name": "Glucocard X-Sensor STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08525011101",
      "ndc_label_name": "GlucoCom Control Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08525011001",
      "ndc_label_name": "GlucoCom Control Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08525010300",
      "ndc_label_name": "GlucoCom Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08525011200",
      "ndc_label_name": "GlucoCom Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08525011300",
      "ndc_label_name": "GlucoCom Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08525010150",
      "ndc_label_name": "GlucoCom Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87473000011",
      "ndc_label_name": "GlucoNavii Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87473000012",
      "ndc_label_name": "GlucoNavii Blood Glucose Test STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41405330301",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405330310",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405530310",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405530301",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405130310",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405130301",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405530810",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405530801",
      "ndc_label_name": "GlucoPro Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405331801",
      "ndc_label_name": "GlucoPro Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41405331810",
      "ndc_label_name": "GlucoPro Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41405531801",
      "ndc_label_name": "GlucoPro Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405531810",
      "ndc_label_name": "GlucoPro Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405131801",
      "ndc_label_name": "GlucoPro Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41405131810",
      "ndc_label_name": "GlucoPro Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396500675",
      "ndc_label_name": "Glucose Meter Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "46122004378",
      "ndc_label_name": "GNP Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042888",
      "ndc_label_name": "GNP Easy Touch Cont High/Low Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496081911",
      "ndc_label_name": "GNP Easy Touch Cont High/Low SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496081905",
      "ndc_label_name": "GNP Easy Touch Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701042886",
      "ndc_label_name": "GNP Easy Touch Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396045064",
      "ndc_label_name": "GNP Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042616",
      "ndc_label_name": "GNP Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38396045164",
      "ndc_label_name": "GNP Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042617",
      "ndc_label_name": "GNP Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042608",
      "ndc_label_name": "GNP Insulin Syringes 28Gx1/2\" 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042610",
      "ndc_label_name": "GNP Insulin Syringes 29Gx1/2\" 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042611",
      "ndc_label_name": "GNP Insulin Syringes 29Gx1/2\" 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042615",
      "ndc_label_name": "GNP Insulin Syringes 31Gx5/16\" 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701052620",
      "ndc_label_name": "GNP Lancing System Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701019061",
      "ndc_label_name": "GNP Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701019065",
      "ndc_label_name": "GNP Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701019063",
      "ndc_label_name": "GNP Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701019024",
      "ndc_label_name": "GNP Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701019060",
      "ndc_label_name": "GNP Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701019064",
      "ndc_label_name": "GNP Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701019062",
      "ndc_label_name": "GNP Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701042604",
      "ndc_label_name": "GNP Sterile Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701042605",
      "ndc_label_name": "GNP Sterile Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701042606",
      "ndc_label_name": "GNP Sterile Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701042653",
      "ndc_label_name": "GNP True Metrix Glucose Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701042627",
      "ndc_label_name": "GNP True Metrix Glucose Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701042626",
      "ndc_label_name": "GNP True Metrix Glucose Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701042760",
      "ndc_label_name": "GNP True Metrix Glucose Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701086657",
      "ndc_label_name": "GNP TrueTrack Smart System Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701086678",
      "ndc_label_name": "GNP TrueTrack Smart System Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "87701040542",
      "ndc_label_name": "GNP Truetrack Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08222720130",
      "ndc_label_name": "GNP UltiCare Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222720055",
      "ndc_label_name": "GNP UltiCare Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222720092",
      "ndc_label_name": "GNP UltiCare Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222720031",
      "ndc_label_name": "GNP UltiCare Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222720078",
      "ndc_label_name": "GNP UltiCare Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222720147",
      "ndc_label_name": "GNP UltiCare Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222720085",
      "ndc_label_name": "GNP UltiCare Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222055538",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222135537",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222135834",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222055835",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222055439",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222135438",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222055620",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222135629",
      "ndc_label_name": "GNP UltiGuard SafePack Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "87701074723",
      "ndc_label_name": "GNP Ultra Com Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50001046232",
      "ndc_label_name": "Gojji Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50001046239",
      "ndc_label_name": "Gojji Blood Test Strip/Lancets Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50001046230",
      "ndc_label_name": "Gojji Blood Test Strip/Lancets Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50001046240",
      "ndc_label_name": "Gojji Control Solution Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50001046210",
      "ndc_label_name": "Gojji Lancing Device/Clear Cap",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50001046235",
      "ndc_label_name": "Gojji Sterile Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50804000701",
      "ndc_label_name": "GoodSense Alcohol Swabs Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "84552050025",
      "ndc_label_name": "Gozellix Configuration A Kit 25 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84552050064",
      "ndc_label_name": "Gozellix Configuration B Kit 25 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59137033501",
      "ndc_label_name": "Grafapex Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59137033500",
      "ndc_label_name": "Grafapex Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59137036501",
      "ndc_label_name": "Grafapex Solution Reconstituted 5 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59137036500",
      "ndc_label_name": "Grafapex Solution Reconstituted 5 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63000041338",
      "ndc_label_name": "Guardian 4 Glucose Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000051968",
      "ndc_label_name": "Guardian 4 Glucose Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000044515",
      "ndc_label_name": "Guardian 4 Transmitter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000044516",
      "ndc_label_name": "Guardian 4 Transmitter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000017962",
      "ndc_label_name": "Guardian Sensor (3)",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000035844",
      "ndc_label_name": "Guardian Sensor (3)",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000033698",
      "ndc_label_name": "Guardian Sensor (3)",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76300017962",
      "ndc_label_name": "Guardian Sensor (3)",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43169070405",
      "ndc_label_name": "Guardian Sensor 3",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08214070727",
      "ndc_label_name": "H-E-B inControl Adv Lancing",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41220025474",
      "ndc_label_name": "H-E-B inControl Alcohol PAD",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214025727",
      "ndc_label_name": "H-E-B inControl Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214065727",
      "ndc_label_name": "H-E-B inControl Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214085727",
      "ndc_label_name": "H-E-B inControl Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214055027",
      "ndc_label_name": "H-E-B inControl Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214050727",
      "ndc_label_name": "H-E-B inControl Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214115027",
      "ndc_label_name": "H-E-B inControl Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214030727",
      "ndc_label_name": "H-E-B inControl Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214040727",
      "ndc_label_name": "H-E-B inControl Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214114027",
      "ndc_label_name": "H-E-B inControl Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214185027",
      "ndc_label_name": "H-E-B inControl Unifine Pentip 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214083027",
      "ndc_label_name": "H-E-B inControl Unifine Pentip 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214183027",
      "ndc_label_name": "H-E-B inControl Unifine Pentip 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214084027",
      "ndc_label_name": "H-E-B inControl Unifine Pentip 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214184027",
      "ndc_label_name": "H-E-B inControl Unifine Pentip 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317035050",
      "ndc_label_name": "Haemolance",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317015001",
      "ndc_label_name": "Haemolance",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317950000",
      "ndc_label_name": "Haemolance Low Flow Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317955000",
      "ndc_label_name": "Haemolance Low Flow Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990250",
      "ndc_label_name": "Haemolance Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990700",
      "ndc_label_name": "Haemolance Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990200",
      "ndc_label_name": "Haemolance Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990750",
      "ndc_label_name": "Haemolance Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990800",
      "ndc_label_name": "Haemolance Plus High Flow",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990900",
      "ndc_label_name": "Haemolance Plus Low Flow",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990950",
      "ndc_label_name": "Haemolance Plus Low Flow",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990600",
      "ndc_label_name": "Haemolance Plus Max Flow",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317990400",
      "ndc_label_name": "Haemolance Plus Pediatric Flow",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62856038901",
      "ndc_label_name": "Halaven Solution 1 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25294000681",
      "ndc_label_name": "HAN-Ease",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72678002007",
      "ndc_label_name": "Haproderm Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090150200",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 1440 EL U/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082652",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 1440 EL U/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082643",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 1440 EL U/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090378100",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 720 EL U/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082543",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 720 EL U/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082552",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 720 EL U/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227099015",
      "ndc_label_name": "HealthWise Insulin Syr/Needle 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227099035",
      "ndc_label_name": "HealthWise Insulin Syr/Needle 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227099045",
      "ndc_label_name": "HealthWise Insulin Syr/Needle 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227099055",
      "ndc_label_name": "HealthWise Insulin Syr/Needle 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227099125",
      "ndc_label_name": "HealthWise Micron Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227099115",
      "ndc_label_name": "HealthWise Short Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227099105",
      "ndc_label_name": "HealthWise Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214030737",
      "ndc_label_name": "HealthWise Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00009085608",
      "ndc_label_name": "Hemabate Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009085605",
      "ndc_label_name": "Hemabate Solution 250 MCG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005105",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005211",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591005105",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591005251",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005311",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005251",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005151",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591005151",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005451",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005405",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591005211",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257005351",
      "ndc_label_name": "HepaGam B Solution 312 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43528000305",
      "ndc_label_name": "Heplisav-B Solution Prefilled Syringe 20 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43528000301",
      "ndc_label_name": "Heplisav-B Solution Prefilled Syringe 20 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090452600",
      "ndc_label_name": "Heplisav-B Solution Prefilled Syringe 20 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75833060101",
      "ndc_label_name": "Hepzato w/50mm Catheter Solution Reconstituted 50 MG Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75833060102",
      "ndc_label_name": "Hepzato w/62mm Catheter Solution Reconstituted 50 MG Intra-arterial",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242007701",
      "ndc_label_name": "Herceptin Hylecta Solution 600-10000 MG-UNT/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242013201",
      "ndc_label_name": "Herceptin Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242013210",
      "ndc_label_name": "Herceptin Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69448001505",
      "ndc_label_name": "Hercessi Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69448001611",
      "ndc_label_name": "Hercessi Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459030343",
      "ndc_label_name": "Herzuma Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459030741",
      "ndc_label_name": "Herzuma Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459030547",
      "ndc_label_name": "Herzuma Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409724813",
      "ndc_label_name": "Hetastarch-NaCl Solution 6-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409724803",
      "ndc_label_name": "Hetastarch-NaCl Solution 6-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409155554",
      "ndc_label_name": "Hextend Solution 6 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409155564",
      "ndc_label_name": "Hextend Solution 6 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081811",
      "ndc_label_name": "Hiberix Solution Reconstituted 10 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081601",
      "ndc_label_name": "Hiberix Solution Reconstituted 10 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160072615",
      "ndc_label_name": "Hiberix Solution Reconstituted 10 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045101",
      "ndc_label_name": "Hizentra SOLUTION 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045190",
      "ndc_label_name": "Hizentra Solution 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045593",
      "ndc_label_name": "Hizentra Solution 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045510",
      "ndc_label_name": "Hizentra SOLUTION 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045202",
      "ndc_label_name": "Hizentra SOLUTION 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045291",
      "ndc_label_name": "Hizentra Solution 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045404",
      "ndc_label_name": "Hizentra SOLUTION 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045492",
      "ndc_label_name": "Hizentra Solution 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045621",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045694",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045525",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045597",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045795",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045722",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045896",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206045824",
      "ndc_label_name": "Hizentra Solution Prefilled Syringe 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52569013305",
      "ndc_label_name": "HM UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52569013306",
      "ndc_label_name": "HM UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08222143896",
      "ndc_label_name": "HM UltiCare Mini Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52569013302",
      "ndc_label_name": "HM UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00002956101",
      "ndc_label_name": "HumatroPen for 12mg DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00002956201",
      "ndc_label_name": "HumatroPen for 24mg DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00002956001",
      "ndc_label_name": "HumatroPen for 6mg DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94030000280",
      "ndc_label_name": "HW Embrace Pro Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000283",
      "ndc_label_name": "HW Embrace Talk Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94030000292",
      "ndc_label_name": "HW Embrace Talk Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "75450031195",
      "ndc_label_name": "Hy-Vee Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "75450031095",
      "ndc_label_name": "Hy-Vee Thin Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00078067461",
      "ndc_label_name": "Hycamtin Solution Reconstituted 4 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60010019573",
      "ndc_label_name": "Hydrogel Wound Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63323085225",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085203",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409263410",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085150",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703011003",
      "ndc_label_name": "HYDROmorphone HCl PF SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703011001",
      "ndc_label_name": "HYDROmorphone HCl PF SOLUTION 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409263401",
      "ndc_label_name": "HYDROmorphone HCl PF SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085107",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085110",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085115",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478054001",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085103",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085303",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085325",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085410",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323085403",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409263425",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 50 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409263405",
      "ndc_label_name": "HYDROmorphone HCl PF SOLUTION 50 MG/5ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478054005",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 50 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703011303",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 50 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703001801",
      "ndc_label_name": "HYDROmorphone HCl PF SOLUTION 500 MG/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409263450",
      "ndc_label_name": "HYDROmorphone HCl PF SOLUTION 500 MG/50ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478054050",
      "ndc_label_name": "HYDROmorphone HCl PF Solution 500 MG/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266911001",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374052930",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641625901",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641625910",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374052950",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266911002",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409180501",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.25 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409180510",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.25 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266912001",
      "ndc_label_name": "HYDROmorphone HCl Solution 0.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409128304",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409128303",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409128337",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409255211",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409426401",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409128331",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374098330",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616901",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409128305",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616910",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266911502",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641620610",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409128317",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409426411",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409255201",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374098350",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374055950",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641620601",
      "ndc_label_name": "HYDROmorphone HCl Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641615125",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409131230",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409131203",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409131236",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409336510",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641234139",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409131216",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641615101",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641234141",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641625401",
      "ndc_label_name": "HYDROmorphone HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409130431",
      "ndc_label_name": "HYDROmorphone HCl Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409130403",
      "ndc_label_name": "HYDROmorphone HCl Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063601",
      "ndc_label_name": "HyperHEP B Solution 220 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063605",
      "ndc_label_name": "HyperHEP B Solution 220 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063610",
      "ndc_label_name": "HyperHEP B Solution 220 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063650",
      "ndc_label_name": "HyperHEP B Solution 220 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063603",
      "ndc_label_name": "HyperHEP B Solution Prefilled Syringe 110 UNIT/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063630",
      "ndc_label_name": "HyperHEP B Solution Prefilled Syringe 110 UNIT/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533031805",
      "ndc_label_name": "HyperRAB Solution 1500 UNIT/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533031850",
      "ndc_label_name": "HyperRAB Solution 1500 UNIT/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533031810",
      "ndc_label_name": "HyperRAB Solution 300 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533031801",
      "ndc_label_name": "HyperRAB Solution 300 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533031830",
      "ndc_label_name": "HyperRAB Solution 900 UNIT/3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533031803",
      "ndc_label_name": "HyperRAB Solution 900 UNIT/3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533066106",
      "ndc_label_name": "HyperRHO Mini-Dose Solution Prefilled Syringe 250 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533066160",
      "ndc_label_name": "HyperRHO Mini-Dose Solution Prefilled Syringe 250 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063102",
      "ndc_label_name": "HyperRHO Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063120",
      "ndc_label_name": "HyperRHO Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063103",
      "ndc_label_name": "HyperRHO Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063111",
      "ndc_label_name": "HyperRHO Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063402",
      "ndc_label_name": "HyperTET Solution Prefilled Syringe 250 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533063420",
      "ndc_label_name": "HyperTET Solution Prefilled Syringe 250 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08317410012",
      "ndc_label_name": "Hypolance AST Lancing KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00944251202",
      "ndc_label_name": "Hyqvia KIT 10 GM/100ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944251002",
      "ndc_label_name": "Hyqvia KIT 2.5 GM/25ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944251302",
      "ndc_label_name": "Hyqvia KIT 20 GM/200ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944251402",
      "ndc_label_name": "Hyqvia KIT 30 GM/300ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944251102",
      "ndc_label_name": "Hyqvia KIT 5 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822103002",
      "ndc_label_name": "Ibuprofen Lysine SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822103001",
      "ndc_label_name": "Ibuprofen Lysine Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993049036",
      "ndc_label_name": "Ibuprofen Lysine SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993049084",
      "ndc_label_name": "Ibuprofen Lysine Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155032631",
      "ndc_label_name": "Ibutilide Fumarate Solution 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457036610",
      "ndc_label_name": "Ibutilide Fumarate Solution 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70100072501",
      "ndc_label_name": "IC Green Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70100082502",
      "ndc_label_name": "IC Green Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013258610",
      "ndc_label_name": "Idamycin PFS Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013258691",
      "ndc_label_name": "Idamycin PFS Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013259620",
      "ndc_label_name": "Idamycin PFS Solution 20 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013259691",
      "ndc_label_name": "Idamycin PFS Solution 20 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013257691",
      "ndc_label_name": "Idamycin PFS Solution 5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013257605",
      "ndc_label_name": "Idamycin PFS Solution 5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288018510",
      "ndc_label_name": "IDArubicin HCl Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143930701",
      "ndc_label_name": "IDArubicin HCl Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703415511",
      "ndc_label_name": "IDArubicin HCl Solution 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143921801",
      "ndc_label_name": "IDArubicin HCl SOLUTION 10 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703415611",
      "ndc_label_name": "IDArubicin HCl Solution 20 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143930801",
      "ndc_label_name": "IDArubicin HCl Solution 20 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143921901",
      "ndc_label_name": "IDArubicin HCl SOLUTION 20 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288018620",
      "ndc_label_name": "IDArubicin HCl Solution 20 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703415411",
      "ndc_label_name": "IDArubicin HCl Solution 5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143921701",
      "ndc_label_name": "IDArubicin HCl SOLUTION 5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288018405",
      "ndc_label_name": "IDArubicin HCl Solution 5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143930601",
      "ndc_label_name": "IDArubicin HCl Solution 5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338399101",
      "ndc_label_name": "Ifex SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338399301",
      "ndc_label_name": "Ifex SOLUTION RECONSTITUTED 3 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143953101",
      "ndc_label_name": "Ifosfamide Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703342711",
      "ndc_label_name": "Ifosfamide Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703342911",
      "ndc_label_name": "Ifosfamide Solution 3 GM/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143953001",
      "ndc_label_name": "Ifosfamide Solution 3 GM/60ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092701",
      "ndc_label_name": "Ifosfamide Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092501",
      "ndc_label_name": "Ifosfamide SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092582",
      "ndc_label_name": "Ifosfamide SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092720",
      "ndc_label_name": "Ifosfamide Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323014210",
      "ndc_label_name": "Ifosfamide SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323014212",
      "ndc_label_name": "Ifosfamide Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092903",
      "ndc_label_name": "Ifosfamide Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092602",
      "ndc_label_name": "Ifosfamide SOLUTION RECONSTITUTED 3 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092616",
      "ndc_label_name": "Ifosfamide SOLUTION RECONSTITUTED 3 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019092960",
      "ndc_label_name": "Ifosfamide Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08539291501",
      "ndc_label_name": "iGlucose Test Strips STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56362000519",
      "ndc_label_name": "IHealth Blood Glucose Test Str Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111000367",
      "ndc_label_name": "IHealth Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50044011816",
      "ndc_label_name": "IHealth Lancing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82667030001",
      "ndc_label_name": "Iheezo Gel 3 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82667030005",
      "ndc_label_name": "Iheezo Gel 3 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74725010025",
      "ndc_label_name": "Illuccix Configuration A Kit 25 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74725010064",
      "ndc_label_name": "Illuccix Configuration B Kit 25 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68611019002",
      "ndc_label_name": "Iluvien IMPLANT 0.19 MG Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005901",
      "ndc_label_name": "Imdelltra Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513010301",
      "ndc_label_name": "Imdelltra Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513006901",
      "ndc_label_name": "Imdelltra Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513007701",
      "ndc_label_name": "Imdelltra Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310450012",
      "ndc_label_name": "Imfinzi Solution 120 MG/2.4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310461150",
      "ndc_label_name": "Imfinzi Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034901",
      "ndc_label_name": "Imipenem-Cilastatin Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034925",
      "ndc_label_name": "Imipenem-Cilastatin Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034994",
      "ndc_label_name": "Imipenem-Cilastatin Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034941",
      "ndc_label_name": "Imipenem-Cilastatin Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034921",
      "ndc_label_name": "Imipenem-Cilastatin Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034993",
      "ndc_label_name": "Imipenem-Cilastatin Solution Reconstituted 250 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310450525",
      "ndc_label_name": "Imjudo Solution 25 MG/1.25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310453530",
      "ndc_label_name": "Imjudo Solution 300 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513007801",
      "ndc_label_name": "Imlygic SUSPENSION 1000000 UNIT/ML Intralesional",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513007901",
      "ndc_label_name": "Imlygic SUSPENSION 100000000 UNIT/ML Intralesional",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624501",
      "ndc_label_name": "Immphentiv Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624510",
      "ndc_label_name": "Immphentiv Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624601",
      "ndc_label_name": "Immphentiv Solution 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641624610",
      "ndc_label_name": "Immphentiv Solution 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53553000500",
      "ndc_label_name": "In Touch Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53553000502",
      "ndc_label_name": "In Touch Glucose Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53553000505",
      "ndc_label_name": "In Touch Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53553000506",
      "ndc_label_name": "In Touch Sterile Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08462109912",
      "ndc_label_name": "In-Check DIAL Flow Trainer DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462109751",
      "ndc_label_name": "In-Check Inspiratory Flow Mtr DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462109750",
      "ndc_label_name": "In-Check Inspiratory Flow Mtr DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "41220067804",
      "ndc_label_name": "InControl UltiCare Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222678044",
      "ndc_label_name": "InControl UltiCare Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222719372",
      "ndc_label_name": "InControl UltiCare Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41220071937",
      "ndc_label_name": "InControl UltiCare Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17156025108",
      "ndc_label_name": "Indium In 111 DTPA Solution Intrathecal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156002101",
      "ndc_label_name": "Indium In 111 Oxyquinoline Solution 1 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710201803",
      "ndc_label_name": "Indocyanine Green Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70100042402",
      "ndc_label_name": "Indocyanine Green Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710203101",
      "ndc_label_name": "Indocyanine Green Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409111301",
      "ndc_label_name": "Indomethacin Sodium Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382047001",
      "ndc_label_name": "Indomethacin Sodium Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065994",
      "ndc_label_name": "Indomethacin Sodium Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065903",
      "ndc_label_name": "Indomethacin Sodium Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323065909",
      "ndc_label_name": "Indomethacin Sodium Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081043",
      "ndc_label_name": "Infanrix SUSPENSION 25-58-10 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081052",
      "ndc_label_name": "Infanrix SUSPENSION 25-58-10 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57513000604",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000600",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000603",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463520350",
      "ndc_label_name": "Infinity Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000607",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000605",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000602",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000601",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000606",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000608",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000609",
      "ndc_label_name": "Infinity Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463510501",
      "ndc_label_name": "Infinity Control Solution High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08463520501",
      "ndc_label_name": "Infinity Control Solution Low In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08463500501",
      "ndc_label_name": "Infinity Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000641",
      "ndc_label_name": "Infinity Voice Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000639",
      "ndc_label_name": "Infinity Voice STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00641603901",
      "ndc_label_name": "Infumorph 200 Solution 200 MG/20ML (10 MG/ML) Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641604001",
      "ndc_label_name": "Infumorph 500 Solution 500 MG/20ML (25 MG/ML) Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25294087400",
      "ndc_label_name": "Inject-Ease",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57894022501",
      "ndc_label_name": "Inlexzo Implant 225 MG Intravesical",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08373208800",
      "ndc_label_name": "InnoSpire Replacement Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085460202",
      "ndc_label_name": "Inspirease",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57515008258",
      "ndc_label_name": "Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917001492",
      "ndc_label_name": "Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917001489",
      "ndc_label_name": "Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917002072",
      "ndc_label_name": "Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08587183529",
      "ndc_label_name": "Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917001487",
      "ndc_label_name": "Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917002528",
      "ndc_label_name": "Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08271352300",
      "ndc_label_name": "Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004815",
      "ndc_label_name": "Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917002536",
      "ndc_label_name": "Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004814",
      "ndc_label_name": "Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004813",
      "ndc_label_name": "Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069553",
      "ndc_label_name": "Insulin Syringe-Needle U-100 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069453",
      "ndc_label_name": "Insulin Syringe-Needle U-100 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069551",
      "ndc_label_name": "Insulin Syringe-Needle U-100 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069552",
      "ndc_label_name": "Insulin Syringe-Needle U-100 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069452",
      "ndc_label_name": "Insulin Syringe-Needle U-100 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069511",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069513",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069512",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069463",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069462",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069562",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069561",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069563",
      "ndc_label_name": "Insulin Syringe-Needle U-100 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069522",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069521",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069523",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000647",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069472",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069572",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069473",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069573",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069571",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57513000646",
      "ndc_label_name": "Insulin Syringe-Needle U-100 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069583",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069581",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069582",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069482",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069483",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069533",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069532",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069531",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57513000650",
      "ndc_label_name": "Insulin Syringe-Needle U-100 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000652",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784069541",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000653",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069542",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069543",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069592",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069593",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069493",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069492",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57513000651",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784069591",
      "ndc_label_name": "Insulin Syringe-Needle U-100 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12383003082",
      "ndc_label_name": "Insupen Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81603290210",
      "ndc_label_name": "Insupen Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15832002004",
      "ndc_label_name": "Insupen Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81603299010",
      "ndc_label_name": "Insupen Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "12383003083",
      "ndc_label_name": "Insupen Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15832002006",
      "ndc_label_name": "Insupen Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81603262010",
      "ndc_label_name": "Insupen Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08271450600",
      "ndc_label_name": "Insupen Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "12383003084",
      "ndc_label_name": "Insupen Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15832002001",
      "ndc_label_name": "Insupen Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "12383003044",
      "ndc_label_name": "Insupen32G Extr3me 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00338051914",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338051909",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053910",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053101",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053901",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338051913",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053110",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338051958",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053301",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053501",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053325",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053550",
      "ndc_label_name": "Intralipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338052013",
      "ndc_label_name": "Intralipid Emulsion 30 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053701",
      "ndc_label_name": "Intralipid Emulsion 30 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219053750",
      "ndc_label_name": "Intralipid Emulsion 30 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00223043857",
      "ndc_label_name": "Intrasite Gel Applipak GEL EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223043855",
      "ndc_label_name": "Intrasite Gel Applipak GEL EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223043856",
      "ndc_label_name": "Intrasite Gel Applipak GEL EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65219038103",
      "ndc_label_name": "Iodixanol Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038110",
      "ndc_label_name": "Iodixanol Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038105",
      "ndc_label_name": "Iodixanol Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038150",
      "ndc_label_name": "Iodixanol Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038350",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038304",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038370",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038302",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038308",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038306",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038305",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038310",
      "ndc_label_name": "Iodixanol Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830246801",
      "ndc_label_name": "Iohexol Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830246802",
      "ndc_label_name": "Iohexol Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990737262",
      "ndc_label_name": "Ionosol-MB in D5W Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990737203",
      "ndc_label_name": "Ionosol-MB in D5W Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012435",
      "ndc_label_name": "Iopamidol Solution 41 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012433",
      "ndc_label_name": "Iopamidol Solution 41 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012452",
      "ndc_label_name": "Iopamidol Solution 41 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012482",
      "ndc_label_name": "Iopamidol Solution 41 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021137",
      "ndc_label_name": "Iopamidol Solution 41 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021180",
      "ndc_label_name": "Iopamidol Solution 41 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012582",
      "ndc_label_name": "Iopamidol Solution 51 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012537",
      "ndc_label_name": "Iopamidol Solution 51 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012634",
      "ndc_label_name": "Iopamidol Solution 61 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012682",
      "ndc_label_name": "Iopamidol Solution 61 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021952",
      "ndc_label_name": "Iopamidol Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021937",
      "ndc_label_name": "Iopamidol Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021962",
      "ndc_label_name": "Iopamidol Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021936",
      "ndc_label_name": "Iopamidol Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021940",
      "ndc_label_name": "Iopamidol Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436021982",
      "ndc_label_name": "Iopamidol Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012782",
      "ndc_label_name": "Iopamidol Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012740",
      "ndc_label_name": "Iopamidol Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281086078",
      "ndc_label_name": "Ipol Suspension Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281086010",
      "ndc_label_name": "Ipol Suspension Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090169300",
      "ndc_label_name": "Ipol Suspension Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963061455",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323019355",
      "ndc_label_name": "Irinotecan HCl SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071505",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143970101",
      "ndc_label_name": "Irinotecan HCl SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714013101",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143958301",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505627201",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742040205",
      "ndc_label_name": "Irinotecan HCl SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963061485",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048022",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700017022",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150035301",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023005",
      "ndc_label_name": "Irinotecan HCl SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505612801",
      "ndc_label_name": "Irinotecan HCl SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021205",
      "ndc_label_name": "Irinotecan HCl Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034909",
      "ndc_label_name": "Irinotecan HCl SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57884300201",
      "ndc_label_name": "Irinotecan HCl SOLUTION 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071615",
      "ndc_label_name": "Irinotecan HCl Solution 300 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021315",
      "ndc_label_name": "Irinotecan HCl Solution 300 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150035401",
      "ndc_label_name": "Irinotecan HCl Solution 300 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700016922",
      "ndc_label_name": "Irinotecan HCl Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048035",
      "ndc_label_name": "Irinotecan HCl Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023002",
      "ndc_label_name": "Irinotecan HCl SOLUTION 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742040102",
      "ndc_label_name": "Irinotecan HCl SOLUTION 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963061451",
      "ndc_label_name": "Irinotecan HCl Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714002701",
      "ndc_label_name": "Irinotecan HCl Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143970201",
      "ndc_label_name": "Irinotecan HCl SOLUTION 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150035201",
      "ndc_label_name": "Irinotecan HCl Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485021102",
      "ndc_label_name": "Irinotecan HCl Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57884300101",
      "ndc_label_name": "Irinotecan HCl SOLUTION 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071402",
      "ndc_label_name": "Irinotecan HCl Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034916",
      "ndc_label_name": "Irinotecan HCl SOLUTION 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505612800",
      "ndc_label_name": "Irinotecan HCl SOLUTION 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323019352",
      "ndc_label_name": "Irinotecan HCl SOLUTION 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034936",
      "ndc_label_name": "Irinotecan HCl SOLUTION 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794001710",
      "ndc_label_name": "Isoflurane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794001725",
      "ndc_label_name": "Isoflurane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264773010",
      "ndc_label_name": "Isolyte-P in D5W SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264770700",
      "ndc_label_name": "Isolyte-S pH 7.4 SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264770710",
      "ndc_label_name": "Isolyte-S pH 7.4 SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264770300",
      "ndc_label_name": "Isolyte-S SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022005",
      "ndc_label_name": "Isosulfan Blue SOLUTION 1 % Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150024005",
      "ndc_label_name": "Isosulfan Blue SOLUTION 1 % Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022000",
      "ndc_label_name": "Isosulfan Blue SOLUTION 1 % Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205019502",
      "ndc_label_name": "Isosulfan Blue Solution 1 % Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043009301",
      "ndc_label_name": "Isosulfan Blue Solution 1 % Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043009306",
      "ndc_label_name": "Isosulfan Blue Solution 1 % Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131430",
      "ndc_label_name": "Isovue-200 Solution 41 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131415",
      "ndc_label_name": "Isovue-200 Solution 41 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131705",
      "ndc_label_name": "Isovue-250 Solution 51 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131702",
      "ndc_label_name": "Isovue-250 Solution 51 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131741",
      "ndc_label_name": "Isovue-250 Solution 51 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131709",
      "ndc_label_name": "Isovue-250 Solution 51 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131545",
      "ndc_label_name": "Isovue-300 Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131550",
      "ndc_label_name": "Isovue-300 Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131530",
      "ndc_label_name": "Isovue-300 Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131525",
      "ndc_label_name": "Isovue-300 Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131595",
      "ndc_label_name": "Isovue-300 Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131547",
      "ndc_label_name": "Isovue-300 Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131535",
      "ndc_label_name": "Isovue-300 Solution 61 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131635",
      "ndc_label_name": "Isovue-370 Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131645",
      "ndc_label_name": "Isovue-370 Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131695",
      "ndc_label_name": "Isovue-370 Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131652",
      "ndc_label_name": "Isovue-370 Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131604",
      "ndc_label_name": "Isovue-370 Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131637",
      "ndc_label_name": "Isovue-370 Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270131630",
      "ndc_label_name": "Isovue-370 Solution 76 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270141111",
      "ndc_label_name": "Isovue-M 200 Solution 41 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270141125",
      "ndc_label_name": "Isovue-M 200 Solution 41 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270141215",
      "ndc_label_name": "Isovue-M 300 Solution 61 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59572098401",
      "ndc_label_name": "Istodax Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505641401",
      "ndc_label_name": "Ivra Solution 90 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70020191001",
      "ndc_label_name": "Ixempra Kit SOLUTION RECONSTITUTED 15 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70020191101",
      "ndc_label_name": "Ixempra Kit SOLUTION RECONSTITUTED 45 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72493010303",
      "ndc_label_name": "Jelmyto Kit 2 x 40 MG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173089803",
      "ndc_label_name": "Jemperli Solution 500 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024582411",
      "ndc_label_name": "Jevtana SOLUTION 60 MG/1.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257000911",
      "ndc_label_name": "Jobevne Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257001011",
      "ndc_label_name": "Jobevne Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50632000102",
      "ndc_label_name": "Jynneos Suspension 0.5 ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50632000101",
      "ndc_label_name": "Jynneos Suspension 0.5 ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50632000103",
      "ndc_label_name": "Jynneos Suspension 0.5 ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071215",
      "ndc_label_name": "Kabiven Emulsion 3.3-10.8-3.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071220",
      "ndc_label_name": "Kabiven Emulsion 3.3-10.8-3.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071210",
      "ndc_label_name": "Kabiven Emulsion 3.3-10.8-3.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071225",
      "ndc_label_name": "Kabiven Emulsion 3.3-10.8-3.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242008801",
      "ndc_label_name": "Kadcyla SOLUTION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242008701",
      "ndc_label_name": "Kadcyla SOLUTION RECONSTITUTED 160 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "05632089200",
      "ndc_label_name": "Kameleon Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632089204",
      "ndc_label_name": "Kameleon Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "55513014121",
      "ndc_label_name": "Kanjinti Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513014101",
      "ndc_label_name": "Kanjinti Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513013201",
      "ndc_label_name": "Kanjinti Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513013221",
      "ndc_label_name": "Kanjinti Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513016401",
      "ndc_label_name": "Kanjinti Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833038702",
      "ndc_label_name": "Kcentra KIT 1000 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833038602",
      "ndc_label_name": "Kcentra KIT 500 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990925739",
      "ndc_label_name": "KCl (0.149%) in NaCl Solution 20-0.45 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990711509",
      "ndc_label_name": "KCl (0.149%) in NaCl Solution 20-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990711609",
      "ndc_label_name": "KCl (0.298%) in NaCl Solution 40-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264763400",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 10-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014210",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 10-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990799309",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 10-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338066904",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 10-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014202",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 10-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338066303",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.2 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264764500",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.2 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338066304",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.2 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219015100",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.225 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219015175",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.225 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990790109",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.225 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219015302",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.225 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219015310",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.225 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338067103",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264763500",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338067104",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014410",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990790209",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219015000",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990790203",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014404",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219015075",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990710709",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338080304",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219011801",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264765200",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219011810",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 20-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990790309",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 30-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338067304",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 30-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264763600",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 30-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014610",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 30-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014606",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 30-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014810",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264763800",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990790409",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014808",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338067504",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.45 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990710909",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338080704",
      "ndc_label_name": "KCl in Dextrose-NaCl SOLUTION 40-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219011910",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219011901",
      "ndc_label_name": "KCl in Dextrose-NaCl Solution 40-5-0.9 MEQ/L-%-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338081104",
      "ndc_label_name": "KCl-Lactated Ringers-D5W SOLUTION 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990711109",
      "ndc_label_name": "KCl-Lactated Ringers-D5W Solution 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76179002503",
      "ndc_label_name": "Kedbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76179002502",
      "ndc_label_name": "Kedbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76179002501",
      "ndc_label_name": "Kedbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76179002504",
      "ndc_label_name": "Kedbumin Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125015010",
      "ndc_label_name": "Kedrab Solution 1500 UNIT/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125015011",
      "ndc_label_name": "Kedrab Solution 1500 UNIT/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125015003",
      "ndc_label_name": "Kedrab Solution 300 UNIT/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125015002",
      "ndc_label_name": "Kedrab Solution 300 UNIT/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080925000",
      "ndc_label_name": "Kendall Amorphous Wound GEL EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080925100",
      "ndc_label_name": "Kendall Amorphous Wound GEL EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122062010",
      "ndc_label_name": "Kengreal SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122062001",
      "ndc_label_name": "Kengreal SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66658011303",
      "ndc_label_name": "Kepivance Solution Reconstituted 5.16 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66658011306",
      "ndc_label_name": "Kepivance Solution Reconstituted 5.16 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71474030120",
      "ndc_label_name": "Keragel GEL External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71474030105",
      "ndc_label_name": "Keragel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71474030220",
      "ndc_label_name": "KeragelT GEL External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71474030205",
      "ndc_label_name": "KeragelT GEL External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023011310",
      "ndc_label_name": "Ketalar SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023011510",
      "ndc_label_name": "Ketalar SOLUTION 100 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023011410",
      "ndc_label_name": "Ketalar SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018401",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043801",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457018100",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457018120",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018420",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068220",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374030805",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043810",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000600",
      "ndc_label_name": "Ketamine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068405",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457010810",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409004005",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572032110",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950901",
      "ndc_label_name": "Ketamine HCl SOLUTION 100 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018605",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409004010",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018613",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150044001",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950910",
      "ndc_label_name": "Ketamine HCl SOLUTION 100 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018601",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409205105",
      "ndc_label_name": "Ketamine HCl SOLUTION 100 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150044010",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409205115",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572032101",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457010800",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018623",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000702",
      "ndc_label_name": "Ketamine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950810",
      "ndc_label_name": "Ketamine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950801",
      "ndc_label_name": "Ketamine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043910",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043901",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018801",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409205310",
      "ndc_label_name": "Ketamine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068310",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572032010",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018810",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52584003810",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572032001",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457000110",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457000100",
      "ndc_label_name": "Ketamine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00193288221",
      "ndc_label_name": "Keto-Diastix STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193288250",
      "ndc_label_name": "Keto-Diastix STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193288350",
      "ndc_label_name": "Keto-Diastix Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00006308301",
      "ndc_label_name": "Keytruda Qlex Solution 395-4800 MG -UNT/2.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006308399",
      "ndc_label_name": "Keytruda Qlex Solution 395-4800 MG -UNT/2.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006508399",
      "ndc_label_name": "Keytruda Qlex Solution 790-9600 MG -UNT/4.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006508301",
      "ndc_label_name": "Keytruda Qlex Solution 790-9600 MG -UNT/4.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006302601",
      "ndc_label_name": "Keytruda Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006302604",
      "ndc_label_name": "Keytruda Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006302602",
      "ndc_label_name": "Keytruda Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72893000401",
      "ndc_label_name": "Khapzory Solution Reconstituted 175 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80446040101",
      "ndc_label_name": "Kimmtrak Solution 100 MCG/0.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16169001012",
      "ndc_label_name": "Kimono",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169001003",
      "ndc_label_name": "Kimono",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169001013",
      "ndc_label_name": "Kimono",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169013012",
      "ndc_label_name": "Kimono Colors DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169003012",
      "ndc_label_name": "Kimono Maxx-Large Flare",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169005003",
      "ndc_label_name": "Kimono Micro Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169005013",
      "ndc_label_name": "Kimono Micro Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169005012",
      "ndc_label_name": "Kimono Micro Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169006013",
      "ndc_label_name": "Kimono Micro Thin Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169006012",
      "ndc_label_name": "Kimono Micro Thin Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169006003",
      "ndc_label_name": "Kimono Micro Thin Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169003013",
      "ndc_label_name": "Kimono Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169003003",
      "ndc_label_name": "Kimono Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169011000",
      "ndc_label_name": "Kimono PS",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169021000",
      "ndc_label_name": "Kimono PS Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169007003",
      "ndc_label_name": "Kimono Sensation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169007013",
      "ndc_label_name": "Kimono Sensation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169007012",
      "ndc_label_name": "Kimono Sensation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169008003",
      "ndc_label_name": "Kimono Sensation Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169008012",
      "ndc_label_name": "Kimono Sensation Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169008013",
      "ndc_label_name": "Kimono Sensation Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169011012",
      "ndc_label_name": "Kimono Special DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00270055615",
      "ndc_label_name": "Kinevac Solution Reconstituted 5 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08214018718",
      "ndc_label_name": "Kinney Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214020718",
      "ndc_label_name": "Kinney Thin Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08881600651",
      "ndc_label_name": "Kinray Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58160081252",
      "ndc_label_name": "Kinrix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081243",
      "ndc_label_name": "Kinrix Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08214027080",
      "ndc_label_name": "Kroger Autolet Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496080911",
      "ndc_label_name": "Kroger HealthPro Control Hi/Lo Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08496080905",
      "ndc_label_name": "Kroger HealthPro Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496080910",
      "ndc_label_name": "Kroger HealthPro Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496080902",
      "ndc_label_name": "Kroger HealthPro Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08496261001",
      "ndc_label_name": "Kroger HealthPro Lancet 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36652030418",
      "ndc_label_name": "Kroger Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36652030318",
      "ndc_label_name": "Kroger Lancets Super Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36652030118",
      "ndc_label_name": "Kroger Lancets Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36652030218",
      "ndc_label_name": "Kroger Lancets Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214055080",
      "ndc_label_name": "Kroger Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214053080",
      "ndc_label_name": "Kroger Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38396070218",
      "ndc_label_name": "Kroger Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214054080",
      "ndc_label_name": "Kroger Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "76075010301",
      "ndc_label_name": "Kyprolis Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76075010321",
      "ndc_label_name": "Kyprolis Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76075010201",
      "ndc_label_name": "Kyprolis SOLUTION RECONSTITUTED 30 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76075010221",
      "ndc_label_name": "Kyprolis Solution Reconstituted 30 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76075010101",
      "ndc_label_name": "Kyprolis SOLUTION RECONSTITUTED 60 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76075010121",
      "ndc_label_name": "Kyprolis Solution Reconstituted 60 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831014250",
      "ndc_label_name": "Kyxata Solution 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831014108",
      "ndc_label_name": "Kyxata Solution 80 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784030782",
      "ndc_label_name": "L-Mesitran Soft Wound Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784030783",
      "ndc_label_name": "L-Mesitran Soft Wound Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338960012",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775007",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775020",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011703",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990795302",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775000",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775010",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990795303",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016424",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047905",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011702",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990795309",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047705",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011704",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338960001",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016475",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047505",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271071007",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016425",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271071005",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016426",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047530",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016474",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016476",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271071006",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047720",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047910",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51709000760",
      "ndc_label_name": "Lancet Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08522000085",
      "ndc_label_name": "Lancet Device with Ejector",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250088304",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614062181",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250088305",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08522000082",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08347100010",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08540003001",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614062178",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250088306",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166001334",
      "ndc_label_name": "Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151024221",
      "ndc_label_name": "Lancets 28G Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08618003001",
      "ndc_label_name": "Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60003012555",
      "ndc_label_name": "Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463702930",
      "ndc_label_name": "Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917021708",
      "ndc_label_name": "Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012582",
      "ndc_label_name": "Lancets Micro Thin 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363237102",
      "ndc_label_name": "Lancets Micro Thin 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012581",
      "ndc_label_name": "Lancets Super Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015020",
      "ndc_label_name": "Lancets Super Thin 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015021",
      "ndc_label_name": "Lancets Super Thin 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50002086060",
      "ndc_label_name": "Lancets Ultra Thin",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08271036100",
      "ndc_label_name": "Lancets Ultra Thin",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08271036200",
      "ndc_label_name": "Lancets Ultra Thin",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012580",
      "ndc_label_name": "Lancets Ultra Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015018",
      "ndc_label_name": "Lancets Ultra Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463382001",
      "ndc_label_name": "Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539900400",
      "ndc_label_name": "Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013481",
      "ndc_label_name": "Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08618000009",
      "ndc_label_name": "Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08271310200",
      "ndc_label_name": "Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003277",
      "ndc_label_name": "Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012969",
      "ndc_label_name": "Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317570015",
      "ndc_label_name": "LANZO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214070734",
      "ndc_label_name": "Leader Advanced Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214050734",
      "ndc_label_name": "Leader Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214040734",
      "ndc_label_name": "Leader Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205057378",
      "ndc_label_name": "Leader Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214385034",
      "ndc_label_name": "Leader Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214383034",
      "ndc_label_name": "Leader Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205057478",
      "ndc_label_name": "Leader Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214384034",
      "ndc_label_name": "Leader Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11994009106",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009110",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009107",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009103",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009101",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009173",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009109",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009112",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009136",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009105",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009192",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009104",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009111",
      "ndc_label_name": "LEU TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323063110",
      "ndc_label_name": "Leucovorin Calcium Solution 100 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323063150",
      "ndc_label_name": "Leucovorin Calcium Solution 500 MG/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021081430",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457052810",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001041636",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016120",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955401",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703514001",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064836",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436011780",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436011880",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 200 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021081530",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 200 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457052920",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 200 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016230",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 200 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064937",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 200 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143936801",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 200 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955301",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 200 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071059",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 200 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071050",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 200 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001041737",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 200 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021081630",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 350 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457053035",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955201",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 350 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436011980",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065038",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703514501",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001041838",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462076735",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703514591",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016330",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 350 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016010",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 50 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021081310",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 50 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955501",
      "ndc_label_name": "Leucovorin Calcium SOLUTION RECONSTITUTED 50 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436011682",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 50 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021082850",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436012080",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071100",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016450",
      "ndc_label_name": "Leucovorin Calcium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598077111",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 175 MG/17.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320194",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 175 MG/17.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121157201",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 175 MG/17.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010518",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 175 MG/17.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436020980",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 175 MG/17.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012001",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 175 MG/17.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012101",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 250 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598077311",
      "ndc_label_name": "LEVOleucovorin Calcium PF Solution 250 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143955801",
      "ndc_label_name": "LEVOleucovorin Calcium Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121109901",
      "ndc_label_name": "LEVOleucovorin Calcium Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010410",
      "ndc_label_name": "LEVOleucovorin Calcium Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409016101",
      "ndc_label_name": "Levophed Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409337514",
      "ndc_label_name": "Levophed Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409016110",
      "ndc_label_name": "Levophed Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409337504",
      "ndc_label_name": "Levophed Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469650189",
      "ndc_label_name": "Lexiscan Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08326003001",
      "ndc_label_name": "Liberty Medical Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61755000801",
      "ndc_label_name": "Libtayo Solution 350 MG/7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427801",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427816",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011730",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471362",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143959501",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143959525",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471302",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427916",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471312",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016102",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011731",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471365",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427902",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471342",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185800",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011702",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471332",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739017027",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015974",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016205",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011705",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011735",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015872",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011734",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471372",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71351002110",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064025",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739017024",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016109",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016324",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016209",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016300",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409471375",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73293000102",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71351002105",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064082",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634065305",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634065302",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016330",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65282160501",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011732",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420008005",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572037025",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064125",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634065342",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420008402",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71351002125",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572037001",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011733",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000310",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603035025",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425026801",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016325",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634065330",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000110",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603035010",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000210",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73293000101",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634065341",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634065343",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409477610",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409477601",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409206610",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249601",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011802",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409428202",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409206605",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143959401",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143959425",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016509",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409428211",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000410",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011805",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409428212",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016072",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094008101",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409428201",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064225",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011833",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84769000202",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011831",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011832",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572037201",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603050510",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016409",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71351002310",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71351002325",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84769000201",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011834",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603041025",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603041001",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000610",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016402",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016505",
      "ndc_label_name": "Lidocaine HCl (PF) SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094008125",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064325",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572037225",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603050525",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000510",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409428301",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 4 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83090000710",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 4 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409428311",
      "ndc_label_name": "Lidocaine HCl (PF) Solution 4 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427501",
      "ndc_label_name": "Lidocaine HCl SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427516",
      "ndc_label_name": "Lidocaine HCl SOLUTION 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011634",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011632",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427617",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102040010",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143917201",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025220",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143957710",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143917210",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090025801",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025110",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011620",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020101",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143957701",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064625",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427601",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155094031",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102040001",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025224",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011631",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020102",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427602",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025350",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427616",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155094041",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374052005",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603073201",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011650",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064586",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020110",
      "ndc_label_name": "Lidocaine HCl SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634065150",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020103",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722011633",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064425",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064687",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025124",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090323801",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064525",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603072225",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374052002",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603073225",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000000",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000001",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603072201",
      "ndc_label_name": "Lidocaine HCl Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427716",
      "ndc_label_name": "Lidocaine HCl SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143957510",
      "ndc_label_name": "Lidocaine HCl SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143917310",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143917301",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722021731",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427717",
      "ndc_label_name": "Lidocaine HCl SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143957501",
      "ndc_label_name": "Lidocaine HCl SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722021733",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025520",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722021720",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722021732",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427701",
      "ndc_label_name": "Lidocaine HCl SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020201",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722021750",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409427702",
      "ndc_label_name": "Lidocaine HCl SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025424",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603082525",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020202",
      "ndc_label_name": "Lidocaine HCl SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603074425",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090336600",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374094932",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025410",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026500",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025650",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000101",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064825",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266909101",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025524",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603074401",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064725",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064786",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756064887",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603082510",
      "ndc_label_name": "Lidocaine HCl Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409120901",
      "ndc_label_name": "Lidocaine-EPINEPHrine (PF) Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409120965",
      "ndc_label_name": "Lidocaine-EPINEPHrine (PF) Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409120910",
      "ndc_label_name": "Lidocaine-EPINEPHrine (PF) Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318101",
      "ndc_label_name": "Lidocaine-EPINEPHrine (PF) Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318111",
      "ndc_label_name": "Lidocaine-EPINEPHrine (PF) Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318301",
      "ndc_label_name": "Lidocaine-EPINEPHrine (PF) Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318311",
      "ndc_label_name": "Lidocaine-EPINEPHrine (PF) Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317716",
      "ndc_label_name": "Lidocaine-Epinephrine Solution 0.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317701",
      "ndc_label_name": "Lidocaine-Epinephrine SOLUTION 0.5 %-1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317818",
      "ndc_label_name": "Lidocaine-Epinephrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317816",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409000710",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409000701",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317803",
      "ndc_label_name": "Lidocaine-Epinephrine SOLUTION 1 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317802",
      "ndc_label_name": "Lidocaine-Epinephrine SOLUTION 1 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317801",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483003700",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409317817",
      "ndc_label_name": "Lidocaine-Epinephrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090034101",
      "ndc_label_name": "Lidocaine-Epinephrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409014701",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00362089805",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43128010515",
      "ndc_label_name": "Lidocaine-Epinephrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318201",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409014710",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66975042551",
      "ndc_label_name": "Lidocaine-Epinephrine SOLUTION 2 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318202",
      "ndc_label_name": "Lidocaine-Epinephrine SOLUTION 2 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00404651205",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318203",
      "ndc_label_name": "Lidocaine-Epinephrine SOLUTION 2 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318221",
      "ndc_label_name": "Lidocaine-Epinephrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58472003250",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318211",
      "ndc_label_name": "Lidocaine-EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318231",
      "ndc_label_name": "Lidocaine-Epinephrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "32671020133",
      "ndc_label_name": "Lite Touch Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671020233",
      "ndc_label_name": "Lite Touch Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671020201",
      "ndc_label_name": "Lite Touch Lancing Pen",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000510",
      "ndc_label_name": "Litetouch Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000500",
      "ndc_label_name": "Litetouch Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000501",
      "ndc_label_name": "Litetouch Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000511",
      "ndc_label_name": "Litetouch Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000506",
      "ndc_label_name": "Litetouch Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000516",
      "ndc_label_name": "Litetouch Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000502",
      "ndc_label_name": "Litetouch Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000512",
      "ndc_label_name": "Litetouch Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000503",
      "ndc_label_name": "Litetouch Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671020513",
      "ndc_label_name": "Litetouch Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000513",
      "ndc_label_name": "Litetouch Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000514",
      "ndc_label_name": "Litetouch Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671020514",
      "ndc_label_name": "Litetouch Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000504",
      "ndc_label_name": "Litetouch Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000508",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671020518",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000518",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000509",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671020519",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000519",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671020520",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000520",
      "ndc_label_name": "Litetouch Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671020333",
      "ndc_label_name": "Litetouch Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373271600",
      "ndc_label_name": "LiteTouch Mask Large",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373271500",
      "ndc_label_name": "LiteTouch Mask Medium",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373271400",
      "ndc_label_name": "LiteTouch Mask Small",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "32671000533",
      "ndc_label_name": "Litetouch Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000532",
      "ndc_label_name": "Litetouch Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671010532",
      "ndc_label_name": "Litetouch Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000534",
      "ndc_label_name": "Litetouch Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671010534",
      "ndc_label_name": "Litetouch Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671010531",
      "ndc_label_name": "Litetouch Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214065726",
      "ndc_label_name": "Live Better Lancet Super Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00409741803",
      "ndc_label_name": "LMD in D5W SOLUTION 10-5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409741813",
      "ndc_label_name": "LMD in D5W SOLUTION 10-5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409741914",
      "ndc_label_name": "LMD in NaCl SOLUTION 10-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409741903",
      "ndc_label_name": "LMD in NaCl SOLUTION 10-0.9 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69488001761",
      "ndc_label_name": "Locametz Kit 25 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078122461",
      "ndc_label_name": "Locametz Kit 25 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70114034001",
      "ndc_label_name": "Loqtorzi Solution 240 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242008288",
      "ndc_label_name": "Lucentis Solution Prefilled Syringe 0.3 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242008203",
      "ndc_label_name": "Lucentis Solution Prefilled Syringe 0.3 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242008003",
      "ndc_label_name": "Lucentis Solution Prefilled Syringe 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242008088",
      "ndc_label_name": "Lucentis Solution Prefilled Syringe 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82292004010",
      "ndc_label_name": "Lumisight Solution Reconstituted 39 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82292004001",
      "ndc_label_name": "Lumisight Solution Reconstituted 39 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46241000536",
      "ndc_label_name": "Lung Perform Peak Flow Meter DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50242015901",
      "ndc_label_name": "Lunsumio Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242014201",
      "ndc_label_name": "Lunsumio Solution 30 MG/30ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242020101",
      "ndc_label_name": "Lunsumio Velo Solution 45 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242017701",
      "ndc_label_name": "Lunsumio Velo Solution 5 MG/0.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52658777701",
      "ndc_label_name": "Lymphir Solution Reconstituted 300 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755005600",
      "ndc_label_name": "Lynozyfic Solution 200 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755005601",
      "ndc_label_name": "Lynozyfic Solution 200 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755005400",
      "ndc_label_name": "Lynozyfic Solution 5 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61755005401",
      "ndc_label_name": "Lynozyfic Solution 5 MG/2.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006468101",
      "ndc_label_name": "M-M-R II Solution Reconstituted Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006468100",
      "ndc_label_name": "M-M-R II Solution Reconstituted Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186000",
      "ndc_label_name": "M-M-R II Solution Reconstituted Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881892930",
      "ndc_label_name": "Magellan Insulin Safety Syr 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881892950",
      "ndc_label_name": "Magellan Insulin Safety Syr 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881892910",
      "ndc_label_name": "Magellan Insulin Safety Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881893050",
      "ndc_label_name": "Magellan Insulin Safety Syr 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990771502",
      "ndc_label_name": "Mannitol Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990771513",
      "ndc_label_name": "Mannitol Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264757810",
      "ndc_label_name": "Mannitol Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990771503",
      "ndc_label_name": "Mannitol Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990771512",
      "ndc_label_name": "Mannitol Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409403116",
      "ndc_label_name": "Mannitol Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323002401",
      "ndc_label_name": "Mannitol Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409403101",
      "ndc_label_name": "Mannitol Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323002425",
      "ndc_label_name": "Mannitol Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66711000041",
      "ndc_label_name": "Marathon Medical Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66711000042",
      "ndc_label_name": "Marathon Medical Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66711000040",
      "ndc_label_name": "Marathon Medical Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409155910",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409251025",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409155918",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409155919",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409155930",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409753501",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409753525",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409251001",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409156029",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409153025",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409153001",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409156018",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409156019",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409501001",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409156010",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409501025",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409225325",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.75 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409225301",
      "ndc_label_name": "Marcaine Preservative Free Solution 0.75 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409158750",
      "ndc_label_name": "Marcaine SOLUTION 0.25 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409161050",
      "ndc_label_name": "Marcaine Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409052501",
      "ndc_label_name": "Marcaine Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409052525",
      "ndc_label_name": "Marcaine Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090187400",
      "ndc_label_name": "Marcaine Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409158219",
      "ndc_label_name": "Marcaine Solution 0.75 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409158218",
      "ndc_label_name": "Marcaine SOLUTION 0.75 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409158210",
      "ndc_label_name": "Marcaine SOLUTION 0.75 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409158229",
      "ndc_label_name": "Marcaine Solution 0.75 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409176110",
      "ndc_label_name": "Marcaine Spinal Solution 0.75-8.25 % Intrathecal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409176162",
      "ndc_label_name": "Marcaine Spinal Solution 0.75-8.25 % Intrathecal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174671",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174610",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174670",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174630",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409573810",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.25-1:200000 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409154110",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.25-1:200000 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409154101",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.25-1:200000 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409573801",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.25-1:200000 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409420810",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174970",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174929",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409812601",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409420801",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174910",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409174971",
      "ndc_label_name": "Marcaine/Epinephrine PF SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409812610",
      "ndc_label_name": "Marcaine/Epinephrine PF Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409175250",
      "ndc_label_name": "Marcaine/Epinephrine SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409381201",
      "ndc_label_name": "Marcaine/Epinephrine Solution 0.25-1:200000 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00362055705",
      "ndc_label_name": "Marcaine/Epinephrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409658101",
      "ndc_label_name": "Marcaine/Epinephrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409175550",
      "ndc_label_name": "Marcaine/Epinephrine SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "89134050202",
      "ndc_label_name": "Maxi-Comfort Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134050302",
      "ndc_label_name": "Maxi-Comfort Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134052702",
      "ndc_label_name": "Maxicomfort syr 27G x 1/2\" 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169002003",
      "ndc_label_name": "Maxx",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169002013",
      "ndc_label_name": "Maxx",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169004003",
      "ndc_label_name": "Maxx Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169004013",
      "ndc_label_name": "Maxx Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16169004012",
      "ndc_label_name": "Maxx Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00019481604",
      "ndc_label_name": "MD-Gastroview Solution 66-10 % Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881608203",
      "ndc_label_name": "Medic Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214502712",
      "ndc_label_name": "MediChoice Safety Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214506712",
      "ndc_label_name": "MediChoice Safety Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214503712",
      "ndc_label_name": "MediChoice Safety Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214504712",
      "ndc_label_name": "MediChoice Safety Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214501712",
      "ndc_label_name": "MediChoice Safety Lancet Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214500712",
      "ndc_label_name": "MediChoice Safety Lancet Norm",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214998921",
      "ndc_label_name": "Medicine Shoppe Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "09958003470",
      "ndc_label_name": "Medihoney Wound/Burn Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "09958003462",
      "ndc_label_name": "Medihoney Wound/Burn Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "09958003471",
      "ndc_label_name": "Medihoney Wound/Burn Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "09958003472",
      "ndc_label_name": "Medihoney Wound/Burn Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "09958003400",
      "ndc_label_name": "Medihoney Wound/Burn Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "09958003460",
      "ndc_label_name": "Medihoney Wound/Burn Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "09958003461",
      "ndc_label_name": "Medihoney Wound/Burn Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57599031201",
      "ndc_label_name": "MediSense Glucose Ketone Contr Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489724510",
      "ndc_label_name": "Medlance Plus Extra 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489704520",
      "ndc_label_name": "Medlance Plus Extra 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489728950",
      "ndc_label_name": "Medlance Plus Extra 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489727925",
      "ndc_label_name": "Medlance Plus Extra 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489704320",
      "ndc_label_name": "Medlance Plus Lite 25G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489727725",
      "ndc_label_name": "Medlance Plus Lite 25G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51028000103",
      "ndc_label_name": "Medlance Plus Lite 25G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489724310",
      "ndc_label_name": "Medlance Plus Lite 25G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489728750",
      "ndc_label_name": "Medlance Plus Lite 25G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51028000125",
      "ndc_label_name": "Medlance Plus Lite 25G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489704620",
      "ndc_label_name": "Medlance Plus Special 0.8mm",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489729050",
      "ndc_label_name": "Medlance Plus Special 0.8mm",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489728025",
      "ndc_label_name": "Medlance Plus Special 0.8mm",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489724610",
      "ndc_label_name": "Medlance Plus Special 0.8mm",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489728650",
      "ndc_label_name": "Medlance Plus SuperLite 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489724120",
      "ndc_label_name": "Medlance Plus SuperLite 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489724210",
      "ndc_label_name": "Medlance Plus SuperLite 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51028000133",
      "ndc_label_name": "Medlance Plus SuperLite 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489727625",
      "ndc_label_name": "Medlance Plus SuperLite 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489704420",
      "ndc_label_name": "Medlance Plus Universal 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489728850",
      "ndc_label_name": "Medlance Plus Universal 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489724410",
      "ndc_label_name": "Medlance Plus Universal 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51028000121",
      "ndc_label_name": "Medlance Plus Universal 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489727825",
      "ndc_label_name": "Medlance Plus Universal 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51028000102",
      "ndc_label_name": "Medlance Plus Universal 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250004081",
      "ndc_label_name": "Meijer Alcohol Swabs PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250004082",
      "ndc_label_name": "Meijer Alcohol Swabs PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38396030320",
      "ndc_label_name": "Meijer Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396030420",
      "ndc_label_name": "Meijer Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250088303",
      "ndc_label_name": "Meijer Lancets Universal 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250003693",
      "ndc_label_name": "Meijer Lancets Universal 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "13733021547",
      "ndc_label_name": "Meijer Lancets Universal 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396031620",
      "ndc_label_name": "Meijer Lancets Universal 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214057717",
      "ndc_label_name": "Meijer Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08820027731",
      "ndc_label_name": "Meijer TRUEtest Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08820027692",
      "ndc_label_name": "Meijer TRUEtest Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "19283024170",
      "ndc_label_name": "Meijer TRUEtrack Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "23155035331",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019501",
      "ndc_label_name": "Melphalan HCl SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010902",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598039248",
      "ndc_label_name": "Melphalan HCl SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963068602",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457057750",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155035541",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598002748",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598002950",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700027897",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021461",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288013015",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010601",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634020261",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025861",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019350",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457057901",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288013290",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323076020",
      "ndc_label_name": "Melphalan HCl SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457021501",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011110",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907011211",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288011290",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012801",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907011111",
      "ndc_label_name": "Melphalan HCl Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281059010",
      "ndc_label_name": "MenQuadfi Solution 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281059005",
      "ndc_label_name": "MenQuadfi Solution 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618001",
      "ndc_label_name": "MenQuadfi Solution 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281059058",
      "ndc_label_name": "MenQuadfi Solution 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618000",
      "ndc_label_name": "MenQuadfi Solution 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082703",
      "ndc_label_name": "Menveo Solution Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082730",
      "ndc_label_name": "Menveo Solution Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160095509",
      "ndc_label_name": "Menveo SOLUTION RECONSTITUTED Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641605401",
      "ndc_label_name": "Meperidine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641605425",
      "ndc_label_name": "Meperidine HCl Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641605225",
      "ndc_label_name": "Meperidine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641605201",
      "ndc_label_name": "Meperidine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641605301",
      "ndc_label_name": "Meperidine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641605325",
      "ndc_label_name": "Meperidine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143943110",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409341201",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567014601",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050821",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594007601",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781309894",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143948610",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143943101",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409139121",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050825",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567040101",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050830",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041610",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150020830",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781309896",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143948601",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409139122",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050845",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594007602",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050831",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021016130",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041001",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050801",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409341210",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567014610",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041010",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041201",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781309895",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121145301",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041601",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121145307",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567040110",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041210",
      "ndc_label_name": "Meropenem Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078008100",
      "ndc_label_name": "Meropenem Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567040201",
      "ndc_label_name": "Meropenem Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567040206",
      "ndc_label_name": "Meropenem Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078008106",
      "ndc_label_name": "Meropenem Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143943001",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001044629",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409022210",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143948510",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409022201",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409139021",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567040001",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567014501",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143943010",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121145401",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409139051",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021016020",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781300094",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781300095",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050701",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150020720",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143948501",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121145407",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001044631",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567040010",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594007501",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781300096",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041110",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050720",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567014510",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041501",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041510",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050725",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041210",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323050721",
      "ndc_label_name": "Meropenem SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594007502",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572041201",
      "ndc_label_name": "Meropenem Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264318511",
      "ndc_label_name": "Meropenem-Sodium Chloride SOLUTION RECONSTITUTED 1 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264318311",
      "ndc_label_name": "Meropenem-Sodium Chloride Solution Reconstituted 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019095110",
      "ndc_label_name": "Mesna Solution 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926001",
      "ndc_label_name": "Mesna Solution 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020111",
      "ndc_label_name": "Mesna SOLUTION 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323073301",
      "ndc_label_name": "Mesna Solution 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020110",
      "ndc_label_name": "Mesna SOLUTION 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019095362",
      "ndc_label_name": "Mesna Solution 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019095105",
      "ndc_label_name": "Mesna Solution 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323073310",
      "ndc_label_name": "Mesna SOLUTION 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019095301",
      "ndc_label_name": "Mesna SOLUTION 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323073311",
      "ndc_label_name": "Mesna SOLUTION 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338130501",
      "ndc_label_name": "Mesnex SOLUTION 100 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478038020",
      "ndc_label_name": "Methadone HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641626601",
      "ndc_label_name": "Methadone HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991000298",
      "ndc_label_name": "Methadone HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298750001",
      "ndc_label_name": "Methadone HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457021720",
      "ndc_label_name": "Methadone HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155089331",
      "ndc_label_name": "Methohexital Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991014417",
      "ndc_label_name": "Methylergonovine Maleate SOLUTION 0.2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991014499",
      "ndc_label_name": "Methylergonovine Maleate SOLUTION 0.2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63704000401",
      "ndc_label_name": "Methylergonovine Maleate SOLUTION 0.2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090453600",
      "ndc_label_name": "Methylergonovine Maleate Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517074001",
      "ndc_label_name": "Methylergonovine Maleate SOLUTION 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517074020",
      "ndc_label_name": "Methylergonovine Maleate SOLUTION 0.2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162159202",
      "ndc_label_name": "Methylergonovine Maleate Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629207401",
      "ndc_label_name": "Methylergonovine Maleate Solution 0.2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76336045518",
      "ndc_label_name": "Metopirone CAPSULE 250 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567072024",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567075001",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954124",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338105548",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013182",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264553532",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409015224",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830246509",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567072001",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335099301",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572054024",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409015201",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830246501",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409781137",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567075024",
      "ndc_label_name": "metroNIDAZOLE Solution 500 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47360017202",
      "ndc_label_name": "Microchamber",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47360001722",
      "ndc_label_name": "Microchamber Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60141025006",
      "ndc_label_name": "Microdot Control High/Low SOLUTION In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51028000172",
      "ndc_label_name": "Microdot Control High/Low SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52422032401",
      "ndc_label_name": "Microdot Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52422020025",
      "ndc_label_name": "Microdot Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52422010050",
      "ndc_label_name": "Microdot Test STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52422020050",
      "ndc_label_name": "Microdot Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51028000175",
      "ndc_label_name": "Microdot Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193658621",
      "ndc_label_name": "Microlet Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193602021",
      "ndc_label_name": "Microlet Next Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00193670201",
      "ndc_label_name": "Microlet Next Lancing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42632073200",
      "ndc_label_name": "Microlife Digital Peak Flow DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71285000101",
      "ndc_label_name": "Microplegia MSA-MSG Solution Perfusion",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47360017201",
      "ndc_label_name": "Microspacer",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "89134075802",
      "ndc_label_name": "Mini Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08462104001",
      "ndc_label_name": "Mini Wright Peak Flow Meter DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "23323001122",
      "ndc_label_name": "Mini Wright Peak Flow Meter Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08462103104",
      "ndc_label_name": "Mini Wright Peak Flow Meter DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08373689800",
      "ndc_label_name": "MiniElite Filter Replacements",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599088000",
      "ndc_label_name": "Minimed Instinct Gluc Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66794016002",
      "ndc_label_name": "Mitigo Solution 200 MG/20ML (10 MG/ML) Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794016202",
      "ndc_label_name": "Mitigo Solution 500 MG/20ML (25 MG/ML) Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025150",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143927901",
      "ndc_label_name": "Mitomycin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143913501",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457051920",
      "ndc_label_name": "Mitomycin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729024711",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729010811",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219056620",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001039077",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061677",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288013850",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150045101",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457099620",
      "ndc_label_name": "Mitomycin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001039078",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819015302",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219056800",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001039180",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150045201",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143913601",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729011638",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928001",
      "ndc_label_name": "MitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001039179",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457099740",
      "ndc_label_name": "MitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457052040",
      "ndc_label_name": "MitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729024838",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025251",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288013951",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061779",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819015404",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061536",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150045001",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729011505",
      "ndc_label_name": "MitoMYcin SOLUTION RECONSTITUTED 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025020",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457051805",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335292701",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729024605",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219056420",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001038936",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819015295",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001038928",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162246402",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288013720",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819015205",
      "ndc_label_name": "mitoMYcin Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703468501",
      "ndc_label_name": "Mitoxantrone HCl Concentrate 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034318",
      "ndc_label_name": "Mitoxantrone HCl CONCENTRATE 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323013210",
      "ndc_label_name": "Mitoxantrone HCl CONCENTRATE 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017810",
      "ndc_label_name": "mitoXANTRONE HCl Concentrate 20 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017913",
      "ndc_label_name": "mitoXANTRONE HCl Concentrate 25 MG/12.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703468001",
      "ndc_label_name": "Mitoxantrone HCl Concentrate 25 MG/12.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323013212",
      "ndc_label_name": "Mitoxantrone HCl CONCENTRATE 25 MG/12.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034365",
      "ndc_label_name": "Mitoxantrone HCl CONCENTRATE 25 MG/12.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703468601",
      "ndc_label_name": "Mitoxantrone HCl Concentrate 30 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034366",
      "ndc_label_name": "Mitoxantrone HCl CONCENTRATE 30 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323013215",
      "ndc_label_name": "Mitoxantrone HCl CONCENTRATE 30 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68196040110",
      "ndc_label_name": "MM BluLink Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68196040105",
      "ndc_label_name": "MM BluLink Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "93968032839",
      "ndc_label_name": "MM BluLink Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "93968032838",
      "ndc_label_name": "MM BluLink Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742023461",
      "ndc_label_name": "MM Easy Touch Glucose STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742025659",
      "ndc_label_name": "MM Insulin Syringe/Needle 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "78742025663",
      "ndc_label_name": "MM Insulin Syringe/Needle 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742025665",
      "ndc_label_name": "MM Insulin Syringe/Needle 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "78742025767",
      "ndc_label_name": "MM Insulin Syringe/Needle 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "78742025771",
      "ndc_label_name": "MM Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68196893101",
      "ndc_label_name": "MM Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68196893301",
      "ndc_label_name": "MM Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68196893001",
      "ndc_label_name": "MM Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "78742025770",
      "ndc_label_name": "MM Twist Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742025769",
      "ndc_label_name": "MM Twist Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80777040060",
      "ndc_label_name": "mNexspike Suspension Prefilled Syringe 10 MCG/0.2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777040061",
      "ndc_label_name": "mNexspike Suspension Prefilled Syringe 10 MCG/0.2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777040062",
      "ndc_label_name": "mNexspike Suspension Prefilled Syringe 10 MCG/0.2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917012579",
      "ndc_label_name": "Mobile Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73535020801",
      "ndc_label_name": "Monjuvi Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50881001303",
      "ndc_label_name": "Monjuvi Solution Reconstituted 200 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881501970",
      "ndc_label_name": "Monoject Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080812701",
      "ndc_label_name": "Monoject Insulin Syringe 27G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080852801",
      "ndc_label_name": "Monoject Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881500014",
      "ndc_label_name": "Monoject Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881501210",
      "ndc_label_name": "Monoject Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080812801",
      "ndc_label_name": "Monoject Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881511144",
      "ndc_label_name": "Monoject Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881600145",
      "ndc_label_name": "Monoject Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881511136",
      "ndc_label_name": "Monoject Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881511110",
      "ndc_label_name": "Monoject Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881511336",
      "ndc_label_name": "Monoject Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881609131",
      "ndc_label_name": "Monoject Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080810055",
      "ndc_label_name": "Monoject Insulin Syringe U-100 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080100707",
      "ndc_label_name": "Monoject Insulin Syringe U-100 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881501384",
      "ndc_label_name": "Monoject Insulin Syringe U-100 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881811558",
      "ndc_label_name": "Monoject Magellan Syringe 25G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08881609004",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881600004",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881609101",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881601101",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881609145",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881609350",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881600350",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881601358",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881609358",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881600700",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881609700",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881609331",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08881609231",
      "ndc_label_name": "Monoject Ultra Comfort Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881602075",
      "ndc_label_name": "Monolet Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08881602018",
      "ndc_label_name": "Monolet Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08881602125",
      "ndc_label_name": "Monolet Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08881602190",
      "ndc_label_name": "Monolet Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08881602034",
      "ndc_label_name": "Monolet Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08881602141",
      "ndc_label_name": "Monolet Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08080602422",
      "ndc_label_name": "Monolet OPD Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08080602091",
      "ndc_label_name": "Monolettor Safety Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00054051741",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629230101",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054051750",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013115",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800312",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808008201",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800315",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808008202",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054051744",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013104",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800324",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629230201",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162128202",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013101",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800330",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162128203",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094035658",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383096530",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121082515",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121082501",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383096504",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121082508",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121082504",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094035601",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 20 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409381412",
      "ndc_label_name": "Morphine Sulfate (PF) SOLUTION 0.5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409381411",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 0.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409381512",
      "ndc_label_name": "Morphine Sulfate (PF) SOLUTION 1 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409381511",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329191201",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323045100",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323045101",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189313",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189303",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189323",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189301",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323045200",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323045201",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189001",
      "ndc_label_name": "Morphine Sulfate (PF) SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189003",
      "ndc_label_name": "Morphine Sulfate (PF) SOLUTION 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189013",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189023",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323045401",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323045400",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189113",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189123",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189101",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189103",
      "ndc_label_name": "Morphine Sulfate (PF) Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612701",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612725",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000411",
      "ndc_label_name": "Morphine Sulfate Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000401",
      "ndc_label_name": "Morphine Sulfate Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619110",
      "ndc_label_name": "Morphine Sulfate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619101",
      "ndc_label_name": "Morphine Sulfate Solution 2 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000511",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045000501",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619201",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619210",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572044001",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612525",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572044025",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612501",
      "ndc_label_name": "Morphine Sulfate Solution 4 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409113405",
      "ndc_label_name": "Morphine Sulfate Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409113403",
      "ndc_label_name": "Morphine Sulfate Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409189620",
      "ndc_label_name": "Morphine Sulfate Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409202201",
      "ndc_label_name": "Morphine Sulfate Solution 50 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612601",
      "ndc_label_name": "Morphine Sulfate Solution 8 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612625",
      "ndc_label_name": "Morphine Sulfate Solution 8 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024586201",
      "ndc_label_name": "Mozobil Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777034563",
      "ndc_label_name": "MResvia Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777034590",
      "ndc_label_name": "MResvia Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777034561",
      "ndc_label_name": "MResvia Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777034596",
      "ndc_label_name": "MResvia Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08317660015",
      "ndc_label_name": "Multi-Lancet Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317660016",
      "ndc_label_name": "Multi-Lancet Device 2 KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65219038702",
      "ndc_label_name": "Multiple Electro Type 1 pH 5.5 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038700",
      "ndc_label_name": "Multiple Electro Type 1 pH 5.5 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038705",
      "ndc_label_name": "Multiple Electro Type 1 pH 5.5 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038710",
      "ndc_label_name": "Multiple Electro Type 1 pH 5.5 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038905",
      "ndc_label_name": "Multiple Electro Type 1 pH 7.4 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038900",
      "ndc_label_name": "Multiple Electro Type 1 pH 7.4 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038902",
      "ndc_label_name": "Multiple Electro Type 1 pH 7.4 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038910",
      "ndc_label_name": "Multiple Electro Type 1 pH 7.4 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69448000338",
      "ndc_label_name": "Mutamycin SOLUTION RECONSTITUTED 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69448000105",
      "ndc_label_name": "Mutamycin SOLUTION RECONSTITUTED 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513020601",
      "ndc_label_name": "Mvasi Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513020621",
      "ndc_label_name": "Mvasi Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513020701",
      "ndc_label_name": "Mvasi Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513020721",
      "ndc_label_name": "Mvasi Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50081000321",
      "ndc_label_name": "MyGlucoHealth Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50081000303",
      "ndc_label_name": "MyGlucoHealth Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50081000301",
      "ndc_label_name": "MyGlucoHealth Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00008451001",
      "ndc_label_name": "Mylotarg Solution Reconstituted 4.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10454071210",
      "ndc_label_name": "Myobloc SOLUTION 10000 UNIT/2ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10454071010",
      "ndc_label_name": "Myobloc SOLUTION 2500 UNIT/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10454071110",
      "ndc_label_name": "Myobloc SOLUTION 5000 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156002630",
      "ndc_label_name": "Myoview 30mL KIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156002405",
      "ndc_label_name": "Myoview Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800420301",
      "ndc_label_name": "Nabi-HB Solution 312 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59730420301",
      "ndc_label_name": "Nabi-HB Solution 312 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800420202",
      "ndc_label_name": "Nabi-HB Solution 312 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800420201",
      "ndc_label_name": "Nabi-HB Solution 312 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800420302",
      "ndc_label_name": "Nabi-HB Solution 312 UNIT/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146461",
      "ndc_label_name": "Nalbuphine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146371",
      "ndc_label_name": "Nalbuphine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146349",
      "ndc_label_name": "Nalbuphine HCl SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146369",
      "ndc_label_name": "Nalbuphine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069066101",
      "ndc_label_name": "Nalbuphine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069067101",
      "ndc_label_name": "Nalbuphine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069066110",
      "ndc_label_name": "Nalbuphine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146301",
      "ndc_label_name": "Nalbuphine HCl SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069067110",
      "ndc_label_name": "Nalbuphine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146401",
      "ndc_label_name": "Nalbuphine HCl SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146571",
      "ndc_label_name": "Nalbuphine HCl Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069067201",
      "ndc_label_name": "Nalbuphine HCl Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146701",
      "ndc_label_name": "Nalbuphine HCl SOLUTION 20 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146501",
      "ndc_label_name": "Nalbuphine HCl SOLUTION 20 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069066201",
      "ndc_label_name": "Nalbuphine HCl Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409146761",
      "ndc_label_name": "Nalbuphine HCl Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069067210",
      "ndc_label_name": "Nalbuphine HCl Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069066210",
      "ndc_label_name": "Nalbuphine HCl Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028801",
      "ndc_label_name": "Naropin Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028829",
      "ndc_label_name": "Naropin SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028803",
      "ndc_label_name": "Naropin Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028806",
      "ndc_label_name": "Naropin Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028807",
      "ndc_label_name": "Naropin Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028811",
      "ndc_label_name": "Naropin SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028821",
      "ndc_label_name": "Naropin SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028810",
      "ndc_label_name": "Naropin SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028820",
      "ndc_label_name": "Naropin SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028823",
      "ndc_label_name": "Naropin Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028827",
      "ndc_label_name": "Naropin SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028557",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028563",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028501",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028565",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028504",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028520",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028541",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028502",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028559",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028573",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028506",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028503",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028510",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028553",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028551",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028568",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028561",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028555",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028507",
      "ndc_label_name": "Naropin Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028513",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028564",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028523",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028567",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028528",
      "ndc_label_name": "Naropin SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028601",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028609",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028600",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028605",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028620",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028623",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028633",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028627",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028638",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028611",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028603",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028631",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028641",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028695",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028663",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028635",
      "ndc_label_name": "Naropin SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028693",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028643",
      "ndc_label_name": "Naropin Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028721",
      "ndc_label_name": "Naropin SOLUTION 7.5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028720",
      "ndc_label_name": "Naropin SOLUTION 7.5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028701",
      "ndc_label_name": "Naropin Solution 7.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028703",
      "ndc_label_name": "Naropin Solution 7.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50027049272",
      "ndc_label_name": "Navage Nasal Aspirator Baby Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73796039150",
      "ndc_label_name": "Nebulizer Air Tube/Plugs",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008249",
      "ndc_label_name": "Nebulizer Cup/Tubing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "26072002349",
      "ndc_label_name": "Nebulizer Mask Adult/Tubing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "26072001121",
      "ndc_label_name": "Nebulizer Mask Ped/Tubing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70710183901",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025950",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598014206",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332081363",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822065001",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598014211",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025951",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710172601",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016553",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121174304",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332081350",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710183908",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81927011101",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121174301",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822065006",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710172608",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205015401",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016552",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81927011106",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016554",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205015404",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81927037501",
      "ndc_label_name": "Nelarabine Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55292012252",
      "ndc_label_name": "NeoProfen SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047727",
      "ndc_label_name": "Nesacaine-MPF SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047701",
      "ndc_label_name": "Nesacaine-MPF Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047827",
      "ndc_label_name": "Nesacaine-MPF SOLUTION 3 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047801",
      "ndc_label_name": "Nesacaine-MPF Solution 3 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69488000140",
      "ndc_label_name": "Netspot KIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54828000101",
      "ndc_label_name": "NeuraCeq Solution 1.4-135 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54828000150",
      "ndc_label_name": "NeuraCeq Solution 1.4-135 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994000602",
      "ndc_label_name": "Neurolite Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "89128000201",
      "ndc_label_name": "Neutek 2Tek Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89128015001",
      "ndc_label_name": "Neutek 2Tek Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89128010001",
      "ndc_label_name": "Neutek 2Tek Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00409080101",
      "ndc_label_name": "Nipent SOLUTION RECONSTITUTED 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00169776411",
      "ndc_label_name": "Nordipen 5 Injection Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00169776413",
      "ndc_label_name": "Nordipen Delivery System",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43066099710",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931801",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931810",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991098317",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703115383",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703115301",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703115303",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703115381",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991098399",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781375595",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288043904",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980063041",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781375575",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021031604",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323094004",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36000016201",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013301",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014002",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298034809",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085204",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066099701",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839014325",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219014004",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36000016210",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013310",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078000200",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085200",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288043905",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335061544",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603018010",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121157601",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335061540",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078000204",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572048110",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121157607",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377012112",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323094021",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634030704",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572048101",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377012111",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603018001",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634030741",
      "ndc_label_name": "Norepinephrine Bitartrate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092903817",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 16-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011620",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 16-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092103817",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 16-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092165517",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 16-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154047315",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 16-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092149117",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 4-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092165317",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 4-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092903417",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 4-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011220",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 4-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092103417",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 4-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338010820",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 8-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092103617",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 8-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092165417",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 8-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092149317",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 8-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092903617",
      "ndc_label_name": "Norepinephrine-Dextrose Solution 8-5 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374053325",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338012820",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338012801",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004077540",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064201",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266502502",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266502602",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004078540",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374053328",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70324092601",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298965803",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092165205",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064210",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154047615",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092146805",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374031525",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266502501",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298965801",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 16-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064301",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 32-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064310",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 32-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71506003258",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 32-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004001",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154047415",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374031925",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064001",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064010",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63037014805",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092103305",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266502002",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004020",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71506002558",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092903305",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266502102",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092165005",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298965903",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374052825",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70324065101",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298965901",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374052828",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004077140",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004078140",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266502001",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 4-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092165105",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064110",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70324067601",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004201",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004220",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004077440",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567064101",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004078440",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154047515",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298965501",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374050425",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374031625",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374050428",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298965503",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092103505",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70324057701",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266501501",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092903505",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71506002758",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266501502",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266501602",
      "ndc_label_name": "Norepinephrine-Sodium Chloride Solution 8-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990796509",
      "ndc_label_name": "Normosol-M in D5W Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990796809",
      "ndc_label_name": "Normosol-R in D5W Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990767003",
      "ndc_label_name": "Normosol-R pH 7.4 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990767009",
      "ndc_label_name": "Normosol-R pH 7.4 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990796709",
      "ndc_label_name": "Normosol-R Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462550047",
      "ndc_label_name": "Nose Clip",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548043437",
      "ndc_label_name": "Nova Max Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548043423",
      "ndc_label_name": "Nova Max Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548043523",
      "ndc_label_name": "Nova Max Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548043416",
      "ndc_label_name": "Nova Max Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548049640",
      "ndc_label_name": "Nova Max Plus Glu/Ket Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08548050939",
      "ndc_label_name": "Nova Safety Lancets 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548050938",
      "ndc_label_name": "Nova Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548043421",
      "ndc_label_name": "Nova Sureflex Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548048738",
      "ndc_label_name": "Nova Sureflex Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548043447",
      "ndc_label_name": "Nova Sureflex Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08548043433",
      "ndc_label_name": "Nova Sureflex Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00169185189",
      "ndc_label_name": "Novofine Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00169185550",
      "ndc_label_name": "NovoFine Plus Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08137002499",
      "ndc_label_name": "Nu-Gel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70710217201",
      "ndc_label_name": "Nufymco Solution 0.3 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710217301",
      "ndc_label_name": "Nufymco Solution 0.5 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527196173",
      "ndc_label_name": "Numbrino Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527196174",
      "ndc_label_name": "Numbrino Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81665030002",
      "ndc_label_name": "Numbrino Solution 40 MG/ML Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264446010",
      "ndc_label_name": "Nutrilipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264446000",
      "ndc_label_name": "Nutrilipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264446030",
      "ndc_label_name": "Nutrilipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069840002",
      "ndc_label_name": "Octagam Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982084001",
      "ndc_label_name": "Octagam SOLUTION 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069840001",
      "ndc_label_name": "Octagam Solution 1 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982085003",
      "ndc_label_name": "Octagam SOLUTION 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069611102",
      "ndc_label_name": "Octagam Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069611101",
      "ndc_label_name": "Octagam Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069847601",
      "ndc_label_name": "Octagam Solution 10 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069847602",
      "ndc_label_name": "Octagam Solution 10 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982084004",
      "ndc_label_name": "Octagam SOLUTION 10 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982085001",
      "ndc_label_name": "Octagam SOLUTION 2 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069600201",
      "ndc_label_name": "Octagam Solution 2 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069600202",
      "ndc_label_name": "Octagam Solution 2 GM/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069842501",
      "ndc_label_name": "Octagam Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069842502",
      "ndc_label_name": "Octagam Solution 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982084002",
      "ndc_label_name": "Octagam SOLUTION 2.5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069623701",
      "ndc_label_name": "Octagam Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982085004",
      "ndc_label_name": "Octagam SOLUTION 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069623702",
      "ndc_label_name": "Octagam Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069633901",
      "ndc_label_name": "Octagam Solution 30 GM/300ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982085005",
      "ndc_label_name": "Octagam Solution 30 GM/300ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069633902",
      "ndc_label_name": "Octagam Solution 30 GM/300ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069845102",
      "ndc_label_name": "Octagam Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069845101",
      "ndc_label_name": "Octagam Solution 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982084003",
      "ndc_label_name": "Octagam SOLUTION 5 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982085002",
      "ndc_label_name": "Octagam SOLUTION 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069655002",
      "ndc_label_name": "Octagam Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069655001",
      "ndc_label_name": "Octagam Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982095201",
      "ndc_label_name": "Octaplas Blood Group A SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982095401",
      "ndc_label_name": "Octaplas Blood Group AB SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982095301",
      "ndc_label_name": "Octaplas Blood Group B SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982095501",
      "ndc_label_name": "Octaplas Blood Group O SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257000111",
      "ndc_label_name": "Ogivri Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457099115",
      "ndc_label_name": "Ogivri Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457084744",
      "ndc_label_name": "Ogivri Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257000412",
      "ndc_label_name": "Ogivri Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457084550",
      "ndc_label_name": "Ogivri Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257000311",
      "ndc_label_name": "Ogivri Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351066501",
      "ndc_label_name": "Ombra Compressor Air Filters",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351063506",
      "ndc_label_name": "Ombra Table Top Compressor Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323020531",
      "ndc_label_name": "Omegaven Emulsion 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020500",
      "ndc_label_name": "Omegaven Emulsion 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020521",
      "ndc_label_name": "Omegaven Emulsion 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323020550",
      "ndc_label_name": "Omegaven Emulsion 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82604060000",
      "ndc_label_name": "Omidria Solution 1-0.3 % Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82604060004",
      "ndc_label_name": "Omidria Solution 1-0.3 % Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62225060000",
      "ndc_label_name": "Omidria Solution 1-0.3 % Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62225060004",
      "ndc_label_name": "Omidria Solution 1-0.3 % Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396602400",
      "ndc_label_name": "Omniflex Diaphragm DIAPHRAGM VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141612",
      "ndc_label_name": "Omnipaque Solution 12 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407140152",
      "ndc_label_name": "Omnipaque Solution 140 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141110",
      "ndc_label_name": "Omnipaque SOLUTION 180 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141120",
      "ndc_label_name": "Omnipaque Solution 180 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141210",
      "ndc_label_name": "Omnipaque SOLUTION 240 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141235",
      "ndc_label_name": "Omnipaque Solution 240 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141233",
      "ndc_label_name": "Omnipaque SOLUTION 240 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141220",
      "ndc_label_name": "Omnipaque SOLUTION 240 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141234",
      "ndc_label_name": "Omnipaque Solution 240 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266648705",
      "ndc_label_name": "Omnipaque Solution 240 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141230",
      "ndc_label_name": "Omnipaque SOLUTION 240 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141238",
      "ndc_label_name": "Omnipaque Solution 240 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141365",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266648803",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141362",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141361",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141363",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141310",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141348",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141366",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141368",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141353",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141372",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141386",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141387",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141359",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141358",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141388",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141389",
      "ndc_label_name": "Omnipaque Solution 300 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141472",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141493",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141408",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141486",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141482",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141448",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141485",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141487",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141484",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141476",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141491",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141490",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141488",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141489",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141494",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141498",
      "ndc_label_name": "Omnipaque Solution 350 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407141509",
      "ndc_label_name": "Omnipaque Solution 9 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08508300001",
      "ndc_label_name": "Omnipod 5 DexG7G6 Intro Gen 5 Kit",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08508300021",
      "ndc_label_name": "Omnipod 5 DexG7G6 Pods Gen 5",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08508300075",
      "ndc_label_name": "Omnipod 5 DexG7G6 Pods Gen 5",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08508300088",
      "ndc_label_name": "Omnipod 5 Libre Intro Kit",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08508300042",
      "ndc_label_name": "Omnipod 5 Libre Pods",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08508200032",
      "ndc_label_name": "Omnipod DASH Intro (Gen 4) Kit",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08508200000",
      "ndc_label_name": "Omnipod DASH PDM (Gen 4) Kit",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08508200005",
      "ndc_label_name": "Omnipod DASH Pods (Gen 4)",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08508112023",
      "ndc_label_name": "Omnipod Pod Pals",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00407069015",
      "ndc_label_name": "Omniscan SOLUTION 287 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407069030",
      "ndc_label_name": "Omniscan Solution 287 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407069005",
      "ndc_label_name": "Omniscan Solution 287 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407069070",
      "ndc_label_name": "Omniscan Solution 287 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407069010",
      "ndc_label_name": "Omniscan SOLUTION 287 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407069040",
      "ndc_label_name": "Omniscan Solution 287 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407069020",
      "ndc_label_name": "Omniscan SOLUTION 287 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82607055729",
      "ndc_label_name": "On Call Express Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72694095401",
      "ndc_label_name": "Oncaspar Solution 750 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59509000603",
      "ndc_label_name": "One Drop Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08462141007",
      "ndc_label_name": "One Flow Spirometer DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12608003002",
      "ndc_label_name": "OneTouch Delica Plus Lancet30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885001110",
      "ndc_label_name": "OneTouch Delica Plus Lancet30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "12608003001",
      "ndc_label_name": "OneTouch Delica Plus Lancet33G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885000810",
      "ndc_label_name": "OneTouch Delica Plus Lancet33G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "12608003005",
      "ndc_label_name": "OneTouch Delica Plus Lancing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885097301",
      "ndc_label_name": "OneTouch Delica Plus Lancing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "12608003026",
      "ndc_label_name": "OneTouch Delica Safety Lancing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "12608003022",
      "ndc_label_name": "OneTouch Delica Safety Lancing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885031820",
      "ndc_label_name": "OneTouch Delica Safety Lancing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885099425",
      "ndc_label_name": "OneTouch Ultra Blue Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885045802",
      "ndc_label_name": "OneTouch Ultra Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885093701",
      "ndc_label_name": "OneTouch Ultra Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885000972",
      "ndc_label_name": "OneTouch Ultra Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885000971",
      "ndc_label_name": "OneTouch Ultra Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885024510",
      "ndc_label_name": "OneTouch Ultra Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885024450",
      "ndc_label_name": "OneTouch Ultra Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885027810",
      "ndc_label_name": "OneTouch UltraSoft 2 Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85654000120",
      "ndc_label_name": "OneTouch UltraSoft 2 Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885033601",
      "ndc_label_name": "OneTouch Verio Flex System Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885012485",
      "ndc_label_name": "OneTouch Verio Flex System Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885001279",
      "ndc_label_name": "OneTouch Verio Flex System Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885001248",
      "ndc_label_name": "OneTouch Verio Flex System Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885026752",
      "ndc_label_name": "OneTouch Verio Flex System Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885000777",
      "ndc_label_name": "OneTouch Verio Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885027402",
      "ndc_label_name": "OneTouch Verio Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885000776",
      "ndc_label_name": "OneTouch Verio Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885027302",
      "ndc_label_name": "OneTouch Verio Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53885000773",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885027150",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885027210",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885000976",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885032850",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885027025",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885000975",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885001278",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53885006150",
      "ndc_label_name": "OneTouch Verio Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "15054004301",
      "ndc_label_name": "Onivyde Suspension 43 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206014701",
      "ndc_label_name": "Ontruzant Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006503302",
      "ndc_label_name": "Ontruzant Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006503301",
      "ndc_label_name": "Ontruzant Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206014799",
      "ndc_label_name": "Ontruzant Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006503401",
      "ndc_label_name": "Ontruzant Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006503402",
      "ndc_label_name": "Ontruzant Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206019199",
      "ndc_label_name": "Ontruzant Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206014899",
      "ndc_label_name": "Ontruzant Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206014801",
      "ndc_label_name": "Ontruzant Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003312001",
      "ndc_label_name": "Opdivo Qvantig Solution 300-5000 MG -UT/2.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003612001",
      "ndc_label_name": "Opdivo Qvantig Solution 600-10000 MG-UT/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003377412",
      "ndc_label_name": "Opdivo Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003375614",
      "ndc_label_name": "Opdivo Solution 120 MG/12ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003373413",
      "ndc_label_name": "Opdivo Solution 240 MG/24ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003377211",
      "ndc_label_name": "Opdivo Solution 40 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003712511",
      "ndc_label_name": "Opdualag Solution 240-80 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08373747800",
      "ndc_label_name": "OptiChamber Diamond",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373983000",
      "ndc_label_name": "OptiChamber Diamond Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373982700",
      "ndc_label_name": "OptiChamber Diamond-Lg Mask Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373982600",
      "ndc_label_name": "OptiChamber Diamond-Md Mask",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373982300",
      "ndc_label_name": "OptiChamber Diamond-Sm Mask",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "34362030201",
      "ndc_label_name": "Options Gynol II Contraceptive GEL 3 % Vaginal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00407270718",
      "ndc_label_name": "Optison SUSPENSION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407270703",
      "ndc_label_name": "Optison SUSPENSION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57599104205",
      "ndc_label_name": "OptiumEZ Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599104104",
      "ndc_label_name": "OptiumEZ Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00338035702",
      "ndc_label_name": "Osmitrol Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338035703",
      "ndc_label_name": "Osmitrol Solution 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703398601",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781931780",
      "ndc_label_name": "Oxaliplatin SOLUTION 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955172720",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781331780",
      "ndc_label_name": "Oxaliplatin SOLUTION 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150033201",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001801",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742040620",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001046837",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955173320",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628704",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729033205",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457044220",
      "ndc_label_name": "Oxaliplatin SOLUTION 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017292",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703036322",
      "ndc_label_name": "Oxaliplatin SOLUTION 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023320",
      "ndc_label_name": "Oxaliplatin SOLUTION 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603032001",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505613207",
      "ndc_label_name": "Oxaliplatin SOLUTION 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012601",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335004740",
      "ndc_label_name": "Oxaliplatin SOLUTION 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010120",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266016201",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323075020",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017221",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288014996",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012610",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603010101",
      "ndc_label_name": "Oxaliplatin Solution 100 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703398501",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729033203",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781331570",
      "ndc_label_name": "Oxaliplatin SOLUTION 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021023310",
      "ndc_label_name": "Oxaliplatin SOLUTION 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781931570",
      "ndc_label_name": "Oxaliplatin SOLUTION 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505613206",
      "ndc_label_name": "Oxaliplatin SOLUTION 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955172510",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323075010",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742040510",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628702",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703036318",
      "ndc_label_name": "Oxaliplatin SOLUTION 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266016101",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017111",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457046910",
      "ndc_label_name": "Oxaliplatin SOLUTION 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955173110",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603030101",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012510",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001046836",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001401",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012501",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335004640",
      "ndc_label_name": "Oxaliplatin SOLUTION 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150033101",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288010110",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288014995",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288017191",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603042001",
      "ndc_label_name": "Oxaliplatin Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219002100",
      "ndc_label_name": "Oxytocin +RFID Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219002101",
      "ndc_label_name": "Oxytocin +RFID Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001230",
      "ndc_label_name": "Oxytocin SOLUTION 10 UNIT/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298051705",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001210",
      "ndc_label_name": "Oxytocin SOLUTION 10 UNIT/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298051905",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001206",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298051910",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001211",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001202",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001207",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001203",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001217",
      "ndc_label_name": "Oxytocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023334807",
      "ndc_label_name": "Ozurdex IMPLANT 0.7 MG Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703321601",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021567",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034222",
      "ndc_label_name": "PACLitaxel CONCENTRATE 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703321681",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332062117",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155088331",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020017",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025517",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323076316",
      "ndc_label_name": "PACLitaxel CONCENTRATE 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205006201",
      "ndc_label_name": "PACLitaxel Concentrate 100 MG/16.7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703321701",
      "ndc_label_name": "PACLitaxel Concentrate 150 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155088231",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021566",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025505",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703321301",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332062005",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020005",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703321381",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205006101",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703001504",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034209",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323076305",
      "ndc_label_name": "PACLitaxel Concentrate 30 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703321801",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323076350",
      "ndc_label_name": "PACLitaxel CONCENTRATE 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714013701",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703321881",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703034250",
      "ndc_label_name": "PACLitaxel CONCENTRATE 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001070527",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155088431",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021025550",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332062250",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860021568",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205006301",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781059507",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001051627",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162264002",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020050",
      "ndc_label_name": "PACLitaxel Concentrate 300 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781353191",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480329001",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457093750",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282076809",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517430001",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623004",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065137",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979071051",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097039878",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288018350",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040801",
      "ndc_label_name": "PACLitaxel Protein-Bound Part Suspension Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51144002001",
      "ndc_label_name": "Padcev Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51144003001",
      "ndc_label_name": "Padcev Solution Reconstituted 30 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55292070254",
      "ndc_label_name": "Panhematin SOLUTION RECONSTITUTED 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55292070255",
      "ndc_label_name": "Panhematin SOLUTION RECONSTITUTED 350 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082204",
      "ndc_label_name": "Panzyga Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069131202",
      "ndc_label_name": "Panzyga Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082284",
      "ndc_label_name": "Panzyga Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069131201",
      "ndc_label_name": "Panzyga Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069110901",
      "ndc_label_name": "Panzyga Solution 2.5 GM/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069110902",
      "ndc_label_name": "Panzyga Solution 2.5 GM/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082282",
      "ndc_label_name": "Panzyga Solution 2.5 GM/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082202",
      "ndc_label_name": "Panzyga Solution 2.5 GM/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069141502",
      "ndc_label_name": "Panzyga Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082205",
      "ndc_label_name": "Panzyga Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069141501",
      "ndc_label_name": "Panzyga Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082285",
      "ndc_label_name": "Panzyga Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082206",
      "ndc_label_name": "Panzyga Solution 30 GM/300ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069155802",
      "ndc_label_name": "Panzyga Solution 30 GM/300ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069155801",
      "ndc_label_name": "Panzyga Solution 30 GM/300ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082286",
      "ndc_label_name": "Panzyga Solution 30 GM/300ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069122402",
      "ndc_label_name": "Panzyga Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069122401",
      "ndc_label_name": "Panzyga Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082203",
      "ndc_label_name": "Panzyga Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982082283",
      "ndc_label_name": "Panzyga Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517400225",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789012107",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288014210",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789012105",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72516002410",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288014201",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517400201",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72516002425",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288014225",
      "ndc_label_name": "Papaverine HCl Solution 30 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83490067805",
      "ndc_label_name": "Pari Altera Nebulizer Handset",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044004",
      "ndc_label_name": "Pari Baby Conversion Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044003",
      "ndc_label_name": "Pari Baby Conversion Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044006",
      "ndc_label_name": "Pari Baby Conversion Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "44229044084",
      "ndc_label_name": "Pari Bubbles Pediatric Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490017806",
      "ndc_label_name": "Pari ERapid Nebulizer Handset",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008284",
      "ndc_label_name": "Pari Expiratory Filter Set DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008276",
      "ndc_label_name": "Pari Manual Interrupter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008225",
      "ndc_label_name": "Pari Mask Set",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490078906",
      "ndc_label_name": "PARI SmartMask Baby/Elbow",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50486008271",
      "ndc_label_name": "Pari Soft Plastic Adult Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008270",
      "ndc_label_name": "Pari Soft Plastic Ped Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490047005",
      "ndc_label_name": "Pari Trek S Combo Pack DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55513074210",
      "ndc_label_name": "Parsabiv SOLUTION 10 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074220",
      "ndc_label_name": "Parsabiv Solution 10 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074201",
      "ndc_label_name": "Parsabiv SOLUTION 10 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074001",
      "ndc_label_name": "Parsabiv SOLUTION 2.5 MG/0.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074010",
      "ndc_label_name": "Parsabiv SOLUTION 2.5 MG/0.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074020",
      "ndc_label_name": "Parsabiv Solution 2.5 MG/0.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074110",
      "ndc_label_name": "Parsabiv SOLUTION 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074101",
      "ndc_label_name": "Parsabiv SOLUTION 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513074120",
      "ndc_label_name": "Parsabiv Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513006501",
      "ndc_label_name": "Pavblu Solution 2 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005601",
      "ndc_label_name": "Pavblu Solution Prefilled Syringe 2 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08214050716",
      "ndc_label_name": "PC Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214057716",
      "ndc_label_name": "PC Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73796066940",
      "ndc_label_name": "Peak A-I-R Flow Meter Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73796069940",
      "ndc_label_name": "Peak Air Peak Flow Meter DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65845001801",
      "ndc_label_name": "Peak Flow Meter Universal Rang DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58160081143",
      "ndc_label_name": "Pediarix Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090754100",
      "ndc_label_name": "Pediarix Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081152",
      "ndc_label_name": "Pediarix Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08439123020",
      "ndc_label_name": "Pediatric Mouthpiece",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73077001001",
      "ndc_label_name": "Pedmark Solution 12.5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409353201",
      "ndc_label_name": "PEMEtrexed Disodium Solution 1 GM/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409000404",
      "ndc_label_name": "PEMEtrexed Disodium Solution 1 GM/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729052235",
      "ndc_label_name": "PEMEtrexed Disodium Solution 1 GM/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781351876",
      "ndc_label_name": "PEMEtrexed Disodium Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729052264",
      "ndc_label_name": "PEMEtrexed Disodium Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409002002",
      "ndc_label_name": "PEMEtrexed Disodium Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409104501",
      "ndc_label_name": "PEMEtrexed Disodium Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001055041",
      "ndc_label_name": "PEMEtrexed Disodium Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409002103",
      "ndc_label_name": "PEMEtrexed Disodium Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781351990",
      "ndc_label_name": "PEMEtrexed Disodium Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409218801",
      "ndc_label_name": "PEMEtrexed Disodium Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729052205",
      "ndc_label_name": "PEMEtrexed Disodium Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001055141",
      "ndc_label_name": "PEMEtrexed Disodium Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016691",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150038101",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598038662",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021026010",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547063201",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729022903",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505606500",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338072001",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323013410",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069083401",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016692",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001053541",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001053841",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742034001",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020210",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016610",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710165401",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054341",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603032501",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505606700",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710167401",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729024438",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062200",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598037074",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288014851",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150038301",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054641",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 1000 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338072201",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710165501",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742034101",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323045050",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021026150",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001053641",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150038201",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001053941",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729023011",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016796",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069083501",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016795",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054441",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603042501",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860020350",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598038711",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505606600",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288016750",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054541",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 750 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062100",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 750 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505606800",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 750 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288014750",
      "ndc_label_name": "PEMEtrexed Disodium Solution Reconstituted 750 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480451501",
      "ndc_label_name": "PEMEtrexed Solution 1 GM/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480451601",
      "ndc_label_name": "PEMEtrexed Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480451401",
      "ndc_label_name": "PEMEtrexed Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71390025002",
      "ndc_label_name": "Pemfexy Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42367053133",
      "ndc_label_name": "Pemfexy Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121245301",
      "ndc_label_name": "Pemrydi RTU Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121246101",
      "ndc_label_name": "Pemrydi RTU Solution 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917013632",
      "ndc_label_name": "Pen Needle/5-Bevel Tip 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013634",
      "ndc_label_name": "Pen Needle/5-Bevel Tip 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784070242",
      "ndc_label_name": "Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784070243",
      "ndc_label_name": "Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784070272",
      "ndc_label_name": "Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784070273",
      "ndc_label_name": "Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013874",
      "ndc_label_name": "Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000627",
      "ndc_label_name": "Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489846810",
      "ndc_label_name": "Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000636",
      "ndc_label_name": "Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489889805",
      "ndc_label_name": "Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000638",
      "ndc_label_name": "Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784070252",
      "ndc_label_name": "Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "96295013876",
      "ndc_label_name": "Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784070253",
      "ndc_label_name": "Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489847010",
      "ndc_label_name": "Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000629",
      "ndc_label_name": "Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396900718",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784070282",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08489847110",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784070283",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000630",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08489889705",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000633",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013877",
      "ndc_label_name": "Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57513000635",
      "ndc_label_name": "Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00069060001",
      "ndc_label_name": "Penbraya Suspension Reconstituted Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069060005",
      "ndc_label_name": "Penbraya Suspension Reconstituted Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069060010",
      "ndc_label_name": "Penbraya Suspension Reconstituted Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281051005",
      "ndc_label_name": "Pentacel Suspension Reconstituted Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281051105",
      "ndc_label_name": "Pentacel Suspension Reconstituted Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090754400",
      "ndc_label_name": "Pentacel Suspension Reconstituted Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011301",
      "ndc_label_name": "Pentam Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323011310",
      "ndc_label_name": "Pentam Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822305001",
      "ndc_label_name": "Pentamidine Isethionate Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121110102",
      "ndc_label_name": "Pentamidine Isethionate Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121110155",
      "ndc_label_name": "Pentamidine Isethionate Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155074831",
      "ndc_label_name": "Pentamidine Isethionate Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155074841",
      "ndc_label_name": "Pentamidine Isethionate Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822305002",
      "ndc_label_name": "Pentamidine Isethionate Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13925051510",
      "ndc_label_name": "Pentamidine Isethionate Solution Reconstituted 300 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70714345001",
      "ndc_label_name": "PenTips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08517345001",
      "ndc_label_name": "PenTips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517045087",
      "ndc_label_name": "PenTips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517045073",
      "ndc_label_name": "PenTips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08517043087",
      "ndc_label_name": "Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517343001",
      "ndc_label_name": "Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517043073",
      "ndc_label_name": "Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70714343001",
      "ndc_label_name": "Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08517344001",
      "ndc_label_name": "Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517044073",
      "ndc_label_name": "Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08517044087",
      "ndc_label_name": "Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70714344001",
      "ndc_label_name": "Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08517059587",
      "ndc_label_name": "Pentips 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470345001",
      "ndc_label_name": "Pentips Generic Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470343001",
      "ndc_label_name": "Pentips Generic Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470344001",
      "ndc_label_name": "Pentips Generic Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470349501",
      "ndc_label_name": "Pentips Generic Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08531010028",
      "ndc_label_name": "Perfect Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08531010030",
      "ndc_label_name": "Perfect Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166022805",
      "ndc_label_name": "Perfect Point Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90166023005",
      "ndc_label_name": "Perfect Point Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63323071414",
      "ndc_label_name": "Perikabiven EMULSION 2.4-6.8-3.5-0.5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071424",
      "ndc_label_name": "Perikabiven Emulsion 2.4-6.8-3.5-0.5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323071419",
      "ndc_label_name": "Perikabiven EMULSION 2.4-6.8-3.5-0.5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242014501",
      "ndc_label_name": "Perjeta Solution 420 MG/14ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08373075500",
      "ndc_label_name": "Personal Best Full Range Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50486008413",
      "ndc_label_name": "Personal Best Full Range DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08373055300",
      "ndc_label_name": "Pflex",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62379000506",
      "ndc_label_name": "Pharmacist Choice Alcohol Pad",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302000105",
      "ndc_label_name": "Pharmacist Choice Alcohol PAD",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302014172",
      "ndc_label_name": "Pharmacist Choice Alcohol PAD",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "98302000133",
      "ndc_label_name": "Pharmacist Choice Autocode STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014071",
      "ndc_label_name": "Pharmacist Choice Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000126",
      "ndc_label_name": "Pharmacist Choice Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000104",
      "ndc_label_name": "Pharmacist Choice Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000106",
      "ndc_label_name": "Pharmacist Choice Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000125",
      "ndc_label_name": "Pharmacist Choice Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000160",
      "ndc_label_name": "Pharmacist Choice Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302014015",
      "ndc_label_name": "Pharmacist Choice Mask Wipes",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62850000022",
      "ndc_label_name": "Pharmacist Choice No Coding STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70069059101",
      "ndc_label_name": "Phenylephrine HCl (PF) Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069059110",
      "ndc_label_name": "Phenylephrine HCl (PF) Solution 0.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374030210",
      "ndc_label_name": "Phenylephrine HCl Solution 1 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092104205",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177011525",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598018205",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092904205",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285702501",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69194097801",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004080840",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449014894",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598018250",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69194097810",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70324070101",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72196702501",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76154049115",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71506000258",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71506002458",
      "ndc_label_name": "Phenylephrine HCl-NaCl Solution 20-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242026001",
      "ndc_label_name": "Phesgo Solution 60-60-2000 MG-MG-U/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242024501",
      "ndc_label_name": "Phesgo Solution 80-40-2000 MG-MG-U/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756020302",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097070996",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121168201",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329124001",
      "ndc_label_name": "Phytonadione SOLUTION 1 MG/0.5ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066013210",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095015401",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021050570",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756020301",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095015402",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121168207",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097000367",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097000396",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097070930",
      "ndc_label_name": "Phytonadione Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598040511",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700033122",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598040516",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145015101",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063501",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063500",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075801",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145015110",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097070831",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700033125",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097070896",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075825",
      "ndc_label_name": "Phytonadione Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08439345011",
      "ndc_label_name": "Piko 1 DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08439345013",
      "ndc_label_name": "Piko 1 DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08439345012",
      "ndc_label_name": "Piko 1 DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08439345010",
      "ndc_label_name": "Piko 1 DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08462005100",
      "ndc_label_name": "Pillow Mask/Adult",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462005110",
      "ndc_label_name": "Pillow Mask/Adult",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462004110",
      "ndc_label_name": "Pillow Mask/Child",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462004100",
      "ndc_label_name": "Pillow Mask/Child",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462003100",
      "ndc_label_name": "Pillow Mask/Pediatric",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462003110",
      "ndc_label_name": "Pillow Mask/Pediatric",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "32671010941",
      "ndc_label_name": "Pip Blood Glucose Test Strip Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671020942",
      "ndc_label_name": "Pip Glucose Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000903",
      "ndc_label_name": "Pip Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000901",
      "ndc_label_name": "Pip Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000902",
      "ndc_label_name": "Pip Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671010932",
      "ndc_label_name": "Pip Pen Needles 31G x 5MM 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671010931",
      "ndc_label_name": "Pip Pen Needles 32G x 4MM 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42023011673",
      "ndc_label_name": "Pitocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023011602",
      "ndc_label_name": "Pitocin SOLUTION 10 UNIT/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023013006",
      "ndc_label_name": "Pitocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023011625",
      "ndc_label_name": "Pitocin SOLUTION 10 UNIT/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023011683",
      "ndc_label_name": "Pitocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023011693",
      "ndc_label_name": "Pitocin Solution 10 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50037080614",
      "ndc_label_name": "Pivot Insulin Pump Starter Kit Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338017903",
      "ndc_label_name": "Plasma-Lyte 148 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338959310",
      "ndc_label_name": "Plasma-Lyte 148 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338017904",
      "ndc_label_name": "Plasma-Lyte 148 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338959301",
      "ndc_label_name": "Plasma-Lyte 148 Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338022104",
      "ndc_label_name": "Plasma-Lyte A Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338022103",
      "ndc_label_name": "Plasma-Lyte A Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409796905",
      "ndc_label_name": "Plegisol SOLUTION PERFUSION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264450000",
      "ndc_label_name": "Plenamine Solution 15 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264450005",
      "ndc_label_name": "Plenamine Solution 15 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598030823",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480432001",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722037331",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162264202",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121169402",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219028412",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021041601",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150035601",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710120801",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288015501",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205024901",
      "ndc_label_name": "Plerixafor Solution 24 MG/1.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006483701",
      "ndc_label_name": "Pneumovax 23 Solution Prefilled Syringe 25 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090703600",
      "ndc_label_name": "Pneumovax 23 Solution Prefilled Syringe 25 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006483703",
      "ndc_label_name": "Pneumovax 23 Solution Prefilled Syringe 25 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08439620210",
      "ndc_label_name": "Pocket Chamber DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08439620201",
      "ndc_label_name": "Pocket Chamber DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08439620250",
      "ndc_label_name": "Pocket Chamber DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08439600101",
      "ndc_label_name": "Pocket Peak Flow Meter DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08439600112",
      "ndc_label_name": "Pocket Peak Flow Meter DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08439620110",
      "ndc_label_name": "Pocket Spacer DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08439620101",
      "ndc_label_name": "Pocket Spacer DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08439620150",
      "ndc_label_name": "Pocket Spacer DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08317630005",
      "ndc_label_name": "PocketChem EZ Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317630050",
      "ndc_label_name": "PocketChem EZ Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50486008321",
      "ndc_label_name": "Pocketpeak Peak Flow Meter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50242010501",
      "ndc_label_name": "Polivy Solution Reconstituted 140 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242010301",
      "ndc_label_name": "Polivy Solution Reconstituted 30 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090451700",
      "ndc_label_name": "Polocaine Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028357",
      "ndc_label_name": "Polocaine Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028301",
      "ndc_label_name": "Polocaine Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323029657",
      "ndc_label_name": "Polocaine Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090440800",
      "ndc_label_name": "Polocaine Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323029601",
      "ndc_label_name": "Polocaine Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026001",
      "ndc_label_name": "Polocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026037",
      "ndc_label_name": "Polocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323029301",
      "ndc_label_name": "Polocaine-MPF Solution 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323029337",
      "ndc_label_name": "Polocaine-MPF Solution 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323029401",
      "ndc_label_name": "Polocaine-MPF Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323029427",
      "ndc_label_name": "Polocaine-MPF Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860012441",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032101",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032112",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143946101",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143946110",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032110",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860012466",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032102",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019610",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010341",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266024901",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023410",
      "ndc_label_name": "Polymyxin B Sulfate SOLUTION RECONSTITUTED 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266024910",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594004902",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010310",
      "ndc_label_name": "Polymyxin B Sulfate Solution Reconstituted 500000 UNIT Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69932000201",
      "ndc_label_name": "Posluma Solution 296-5846 MBQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60007087776",
      "ndc_label_name": "Post-Surgical Skin Barrier Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00338070434",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 20-0.45 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323068301",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 20-0.45 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323068310",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 20-0.45 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323068601",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 20-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338069104",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 20-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264786500",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 20-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323068610",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 20-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323068810",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 40-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323068801",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 40-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338069504",
      "ndc_label_name": "Potassium Chloride in NaCl Solution 40-0.9 MEQ/L-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066701",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 10 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066710",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 10 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990790509",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264762500",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066910",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409790509",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338068304",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066901",
      "ndc_label_name": "Potassium Cl in Dextrose 5% Solution 20 MEQ/L Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145019401",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219005209",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145019425",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517205125",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517205101",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069074625",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078625",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078605",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219005229",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097007867",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323008605",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097007897",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830169303",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069074601",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830169301",
      "ndc_label_name": "Potassium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145019601",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517250501",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830169201",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145019625",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097005567",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219005629",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323008650",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219005609",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097005597",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517250525",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830169202",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078850",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078825",
      "ndc_label_name": "Potassium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069074701",
      "ndc_label_name": "Potassium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069074725",
      "ndc_label_name": "Potassium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517210225",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409003201",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409729501",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517210201",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409003210",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145019525",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219005429",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097007767",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145019501",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409729511",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097007797",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219005409",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078715",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462078725",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572023225",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830169102",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830169101",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572023201",
      "ndc_label_name": "Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219065601",
      "ndc_label_name": "Potassium Phosphates-NaCl Solution 15 MMOL/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219065610",
      "ndc_label_name": "Potassium Phosphates-NaCl Solution 15 MMOL/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004084140",
      "ndc_label_name": "Potassium Phosphates-NaCl Solution 15 MMOL/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219065825",
      "ndc_label_name": "Potassium Phosphates-NaCl Solution 15 MMOL/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121172209",
      "ndc_label_name": "Potassium Phosphates-NaCl Solution 15 MMOL/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219065801",
      "ndc_label_name": "Potassium Phosphates-NaCl Solution 15 MMOL/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121172201",
      "ndc_label_name": "Potassium Phosphates-NaCl Solution 15 MMOL/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42747076101",
      "ndc_label_name": "Poteligeo Solution 20 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598034211",
      "ndc_label_name": "PRALAtrexate Solution 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219055001",
      "ndc_label_name": "PRALAtrexate Solution 20 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219055202",
      "ndc_label_name": "PRALAtrexate Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598034323",
      "ndc_label_name": "PRALAtrexate Solution 40 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409143401",
      "ndc_label_name": "Precedex Solution 1000 MCG/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409281501",
      "ndc_label_name": "Precedex Solution 1000 MCG/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409787512",
      "ndc_label_name": "Precedex Solution 1000 MCG/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409787501",
      "ndc_label_name": "Precedex Solution 1000 MCG/250ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163832",
      "ndc_label_name": "Precedex Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163802",
      "ndc_label_name": "Precedex Solution 200 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409459601",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409145401",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409145420",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409166050",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409166055",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409783824",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409459620",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409783801",
      "ndc_label_name": "Precedex Solution 200 MCG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409015501",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409166035",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409117401",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409015502",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409166010",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409785301",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409159610",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409117410",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409159601",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409785324",
      "ndc_label_name": "Precedex Solution 400 MCG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409166020",
      "ndc_label_name": "Precedex Solution 80 MCG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409166022",
      "ndc_label_name": "Precedex Solution 80 MCG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330110",
      "ndc_label_name": "Precedex Solution 80 MCG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330101",
      "ndc_label_name": "Precedex Solution 80 MCG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57599013901",
      "ndc_label_name": "Precision Glucose Ketone Contr Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57599972804",
      "ndc_label_name": "Precision Xtra Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599969405",
      "ndc_label_name": "Precision Xtra Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599969504",
      "ndc_label_name": "Precision Xtra Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599987805",
      "ndc_label_name": "Precision Xtra Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599983804",
      "ndc_label_name": "Precision Xtra Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57599987705",
      "ndc_label_name": "Precision Xtra Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00338113006",
      "ndc_label_name": "Premasol SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113004",
      "ndc_label_name": "Premasol SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338113003",
      "ndc_label_name": "Premasol SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009335901",
      "ndc_label_name": "Prepidil GEL 0.5 MG/3GM VAGINAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023026905",
      "ndc_label_name": "Prevduo Solution Prefilled Syringe 3-0.6 MG/3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023026901",
      "ndc_label_name": "Prevduo Solution Prefilled Syringe 3-0.6 MG/3ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38703857810",
      "ndc_label_name": "Prevent DropSafe Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68599857810",
      "ndc_label_name": "Prevent Safety Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090602600",
      "ndc_label_name": "Prevnar 20 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00005200002",
      "ndc_label_name": "Prevnar 20 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090602601",
      "ndc_label_name": "Prevnar 20 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00005200010",
      "ndc_label_name": "Prevnar 20 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043791",
      "ndc_label_name": "Privigen Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043710",
      "ndc_label_name": "Privigen SOLUTION 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043820",
      "ndc_label_name": "Privigen SOLUTION 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043892",
      "ndc_label_name": "Privigen SOLUTION 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043940",
      "ndc_label_name": "Privigen SOLUTION 40 GM/400ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043993",
      "ndc_label_name": "Privigen Solution 40 GM/400ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043605",
      "ndc_label_name": "Privigen SOLUTION 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206043690",
      "ndc_label_name": "Privigen Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50058086428",
      "ndc_label_name": "Pro Comfort Alcohol Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000703",
      "ndc_label_name": "Pro Comfort Alcohol PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000708",
      "ndc_label_name": "Pro Comfort Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000709",
      "ndc_label_name": "Pro Comfort Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50058086404",
      "ndc_label_name": "Pro Comfort Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000707",
      "ndc_label_name": "Pro Comfort Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000706",
      "ndc_label_name": "Pro Comfort Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50058086405",
      "ndc_label_name": "Pro Comfort Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000705",
      "ndc_label_name": "Pro Comfort Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50058086406",
      "ndc_label_name": "Pro Comfort Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000701",
      "ndc_label_name": "Pro Comfort Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000712",
      "ndc_label_name": "Pro Comfort Lancets 31G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000700",
      "ndc_label_name": "Pro Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50632000704",
      "ndc_label_name": "Pro Comfort Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049454",
      "ndc_label_name": "Pro Comfort Safety Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000727",
      "ndc_label_name": "Pro Comfort Spacer Adult",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000728",
      "ndc_label_name": "Pro Comfort Spacer Child",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000756",
      "ndc_label_name": "Pro Comfort Spacer Infant Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001274",
      "ndc_label_name": "Pro Voice V8/V9 Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72217003901",
      "ndc_label_name": "Procare Spacer/Adult Mask Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72217003902",
      "ndc_label_name": "Procare Spacer/Child Mask Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373917700",
      "ndc_label_name": "ProChamber VHC Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08484053350",
      "ndc_label_name": "Prodigy Control Solution SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08484990310",
      "ndc_label_name": "Prodigy Control Solution SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08484053310",
      "ndc_label_name": "Prodigy Control Solution SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08484990432",
      "ndc_label_name": "Prodigy Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08484990430",
      "ndc_label_name": "Prodigy Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08484990438",
      "ndc_label_name": "Prodigy Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484990437",
      "ndc_label_name": "Prodigy Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08484990435",
      "ndc_label_name": "Prodigy Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08484990338",
      "ndc_label_name": "Prodigy Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484990355",
      "ndc_label_name": "Prodigy Lancing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484073200",
      "ndc_label_name": "Prodigy No Coding Blood Gluc STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484072500",
      "ndc_label_name": "Prodigy No Coding Blood Gluc STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484052800",
      "ndc_label_name": "Prodigy No Coding Blood Gluc STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484075300",
      "ndc_label_name": "Prodigy No Coding Blood Gluc STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484082026",
      "ndc_label_name": "Prodigy Safety Lancets 26G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484081028",
      "ndc_label_name": "Prodigy Twist Top Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08484990328",
      "ndc_label_name": "Prodigy Twist Top Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00469301601",
      "ndc_label_name": "Prograf Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270111103",
      "ndc_label_name": "Prohance Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270111104",
      "ndc_label_name": "Prohance Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270111102",
      "ndc_label_name": "Prohance Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270111101",
      "ndc_label_name": "Prohance Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270111145",
      "ndc_label_name": "Prohance Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270111170",
      "ndc_label_name": "Prohance Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00270111116",
      "ndc_label_name": "Prohance Solution 279.3 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83490085007",
      "ndc_label_name": "Proneb Ultra Filter Set",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72572061210",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619601",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409469924",
      "ndc_label_name": "Propofol EMULSION 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409469954",
      "ndc_label_name": "Propofol EMULSION 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155034533",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069024810",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069024801",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155034543",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598054910",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073153",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714069001",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591213657",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634060351",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714069010",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598054952",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058510",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591213668",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634060343",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058501",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572061201",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619610",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236501",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236507",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021060851",
      "ndc_label_name": "Propofol EMULSION 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073152",
      "ndc_label_name": "Propofol Emulsion 1000 MG/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052810",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619410",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409601002",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069020910",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052820",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591213695",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069020901",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409601025",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155034541",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021060820",
      "ndc_label_name": "Propofol EMULSION 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598026520",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619401",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155034544",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072920",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830118801",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591213680",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058310",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072921",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598026525",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058301",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634060320",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572059010",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572059001",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830118807",
      "ndc_label_name": "Propofol Emulsion 200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069023401",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069023420",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409469933",
      "ndc_label_name": "Propofol EMULSION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409469953",
      "ndc_label_name": "Propofol EMULSION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714097701",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591213651",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591213655",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073050",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619501",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058420",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641619520",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714097720",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598054821",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572060120",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155034532",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073051",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021060850",
      "ndc_label_name": "Propofol EMULSION 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058401",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155034542",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236408",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598054850",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572060101",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090456901",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830236401",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634060350",
      "ndc_label_name": "Propofol Emulsion 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006417101",
      "ndc_label_name": "ProQuad Suspension Reconstituted Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006417100",
      "ndc_label_name": "ProQuad Suspension Reconstituted Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338049906",
      "ndc_label_name": "Prosol SOLUTION 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022901",
      "ndc_label_name": "Protamine Sulfate Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022905",
      "ndc_label_name": "Protamine Sulfate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022994",
      "ndc_label_name": "Protamine Sulfate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022935",
      "ndc_label_name": "Protamine Sulfate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022995",
      "ndc_label_name": "Protamine Sulfate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022941",
      "ndc_label_name": "Protamine Sulfate Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022915",
      "ndc_label_name": "Protamine Sulfate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022921",
      "ndc_label_name": "Protamine Sulfate Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323022930",
      "ndc_label_name": "Protamine Sulfate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81932071301",
      "ndc_label_name": "PTS Panels eGlu Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60006037783",
      "ndc_label_name": "Pure Comfort 3-Ball Breathe Ex Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60003012550",
      "ndc_label_name": "Pure Comfort Alcohol Prep Pad",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60000052659",
      "ndc_label_name": "Pure Comfort Flow Meter Adult Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60003012557",
      "ndc_label_name": "Pure Comfort Flow Meter Child Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60006037781",
      "ndc_label_name": "Pure Comfort Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60003012551",
      "ndc_label_name": "Pure Comfort Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60003012553",
      "ndc_label_name": "Pure Comfort Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50071076508",
      "ndc_label_name": "Pure Comfort Safety Lancet 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000790",
      "ndc_label_name": "Pure Comfort Safety Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000789",
      "ndc_label_name": "Pure Comfort Safety Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049441",
      "ndc_label_name": "Pure Comfort Spacer Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214070729",
      "ndc_label_name": "PX Advanced Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214027429",
      "ndc_label_name": "PX Advanced Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227018525",
      "ndc_label_name": "PX Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214058529",
      "ndc_label_name": "PX Lancets MicroThin 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214056529",
      "ndc_label_name": "PX Lancets Ultra Thin 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214085029",
      "ndc_label_name": "PX Mini Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71258002201",
      "ndc_label_name": "Pylarify Solution 1-80 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71258002200",
      "ndc_label_name": "Pylarify Solution Prefilled Syringe 9 MCI Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08214027033",
      "ndc_label_name": "QC Advanced Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63868098903",
      "ndc_label_name": "QC Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214046533",
      "ndc_label_name": "QC Lancets Super Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214053533",
      "ndc_label_name": "QC Lancets Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214353033",
      "ndc_label_name": "QC Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214354033",
      "ndc_label_name": "QC Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35515096943",
      "ndc_label_name": "QC Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214056533",
      "ndc_label_name": "QC Unilet Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214058733",
      "ndc_label_name": "QC Unilet Lancets Micro Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76179001003",
      "ndc_label_name": "Qivigy Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76179001004",
      "ndc_label_name": "Qivigy Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76179001002",
      "ndc_label_name": "Qivigy Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76179001001",
      "ndc_label_name": "Qivigy Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281056410",
      "ndc_label_name": "Quadracel Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281056458",
      "ndc_label_name": "Quadracel Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281056210",
      "ndc_label_name": "Quadracel Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281056258",
      "ndc_label_name": "Quadracel Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281056415",
      "ndc_label_name": "Quadracel Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281056488",
      "ndc_label_name": "Quadracel Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08348129700",
      "ndc_label_name": "Quake Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00409662902",
      "ndc_label_name": "Quelicin Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409662912",
      "ndc_label_name": "Quelicin Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73317950905",
      "ndc_label_name": "Quick Touch Blood Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73317971207",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317960505",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317610905",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317666605",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317681605",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317610908",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317960508",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317612904",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317960604",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317960606",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73317612906",
      "ndc_label_name": "Quick Touch Insulin Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317330501",
      "ndc_label_name": "QuickTek Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317330000",
      "ndc_label_name": "QuickTek Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317335050",
      "ndc_label_name": "QuickTek Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89115005902",
      "ndc_label_name": "Quintet AC Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89115005102",
      "ndc_label_name": "Quintet Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89115005202",
      "ndc_label_name": "Quintet Control High/Normal SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00009043601",
      "ndc_label_name": "R-Gene 10 SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66977010105",
      "ndc_label_name": "RadiaPlexRx GEL EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66977010106",
      "ndc_label_name": "RadiaPlexRx Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66977010606",
      "ndc_label_name": "RadiaPlexRx Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82098000210",
      "ndc_label_name": "Raya Sure Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "82098000410",
      "ndc_label_name": "Raya Sure Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32671000802",
      "ndc_label_name": "ReadyLance Safety Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000803",
      "ndc_label_name": "ReadyLance Safety Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000804",
      "ndc_label_name": "ReadyLance Safety Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000805",
      "ndc_label_name": "ReadyLance Safety Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "32671000806",
      "ndc_label_name": "ReadyLance Safety Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250093187",
      "ndc_label_name": "Reality Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250093188",
      "ndc_label_name": "Reality Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250056588",
      "ndc_label_name": "Reality Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250056587",
      "ndc_label_name": "Reality Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250084211",
      "ndc_label_name": "Reality Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250052813",
      "ndc_label_name": "Reality Latex Condoms",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "19283092332",
      "ndc_label_name": "Reality Latex/Ultra Textured DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "19283023271",
      "ndc_label_name": "Reality Latex/Ultra Thin DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250064279",
      "ndc_label_name": "Reality Swabs PAD",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250066828",
      "ndc_label_name": "Reality Trigger Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00006385601",
      "ndc_label_name": "Recarbrio Solution Reconstituted 1.25 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006385602",
      "ndc_label_name": "Recarbrio Solution Reconstituted 1.25 GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006499500",
      "ndc_label_name": "Recombivax HB Suspension 10 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006499501",
      "ndc_label_name": "Recombivax HB Suspension 10 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006499541",
      "ndc_label_name": "Recombivax HB SUSPENSION 10 MCG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006499200",
      "ndc_label_name": "Recombivax HB SUSPENSION 40 MCG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006499201",
      "ndc_label_name": "Recombivax HB SUSPENSION 40 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006498100",
      "ndc_label_name": "Recombivax HB SUSPENSION 5 MCG/0.5ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006498101",
      "ndc_label_name": "Recombivax HB SUSPENSION 5 MCG/0.5ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569655500",
      "ndc_label_name": "Recombivax HB Suspension Prefilled Syringe 10 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409401",
      "ndc_label_name": "Recombivax HB Suspension Prefilled Syringe 10 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409402",
      "ndc_label_name": "Recombivax HB Suspension Prefilled Syringe 10 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409301",
      "ndc_label_name": "Recombivax HB Suspension Prefilled Syringe 5 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409302",
      "ndc_label_name": "Recombivax HB Suspension Prefilled Syringe 5 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65293000701",
      "ndc_label_name": "Recothrom Solution Reconstituted 20000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338032601",
      "ndc_label_name": "Recothrom Solution Reconstituted 20000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65293000741",
      "ndc_label_name": "Recothrom Solution Reconstituted 20000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338032801",
      "ndc_label_name": "Recothrom Solution Reconstituted 20000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65293000601",
      "ndc_label_name": "Recothrom Solution Reconstituted 5000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338032401",
      "ndc_label_name": "Recothrom Solution Reconstituted 5000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338032201",
      "ndc_label_name": "Recothrom Solution Reconstituted 5000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65293000641",
      "ndc_label_name": "Recothrom Solution Reconstituted 5000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65293000750",
      "ndc_label_name": "Recothrom Spray Kit Solution Reconstituted 20000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338033001",
      "ndc_label_name": "Recothrom Spray Kit Solution Reconstituted 20000 UNIT External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "37654049727",
      "ndc_label_name": "RefuAH Plus Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37654049728",
      "ndc_label_name": "RefuAH Plus Glucose Control SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16729047731",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409140105",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641625301",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505628800",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598061611",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409140101",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135080351",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "36000036401",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329332100",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150044301",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611087410",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288020185",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505611600",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457099405",
      "ndc_label_name": "Regadenoson Solution 0.4 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81306041113",
      "ndc_label_name": "ReliOn Alcohol Swabs PAD",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131006044",
      "ndc_label_name": "ReliOn Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317780100",
      "ndc_label_name": "ReliOn Blood Glucose Test STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317780050",
      "ndc_label_name": "ReliOn Blood Glucose Test STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317710050",
      "ndc_label_name": "ReliOn Confirm/micro Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317712020",
      "ndc_label_name": "ReliOn Confirm/micro Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317712100",
      "ndc_label_name": "ReliOn Confirm/micro Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702070120",
      "ndc_label_name": "ReliOn Glucose Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65702070110",
      "ndc_label_name": "ReliOn Glucose Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131031164",
      "ndc_label_name": "ReliOn Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131031165",
      "ndc_label_name": "ReliOn Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131013839",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131013838",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131013836",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131013837",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131013834",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131013835",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131031178",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131031179",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131031177",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131031176",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131031174",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131031175",
      "ndc_label_name": "ReliOn Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131013347",
      "ndc_label_name": "ReliOn Lancet Devices 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489860150",
      "ndc_label_name": "ReliOn Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08489860050",
      "ndc_label_name": "ReliOn Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742002648",
      "ndc_label_name": "ReliOn Lancets Micro-Thin 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396044902",
      "ndc_label_name": "ReliOn Lancets Thin 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131006041",
      "ndc_label_name": "ReliOn Lancets Thin 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396045202",
      "ndc_label_name": "ReliOn Lancets Ultra-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396045102",
      "ndc_label_name": "ReliOn Lancets Ultra-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396045302",
      "ndc_label_name": "ReliOn Lancets Ultra-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131009885",
      "ndc_label_name": "ReliOn Lancets Ultra-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742002646",
      "ndc_label_name": "ReliOn Lancets Ultra-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131006040",
      "ndc_label_name": "ReliOn Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396050101",
      "ndc_label_name": "ReliOn Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396047002",
      "ndc_label_name": "ReliOn Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131038681",
      "ndc_label_name": "ReliOn Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396901634",
      "ndc_label_name": "ReliOn Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396901334",
      "ndc_label_name": "ReliOn Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131002313",
      "ndc_label_name": "ReliOn Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396902700",
      "ndc_label_name": "ReliOn Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396901434",
      "ndc_label_name": "ReliOn Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08396903500",
      "ndc_label_name": "ReliOn Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131038679",
      "ndc_label_name": "ReliOn Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317780025",
      "ndc_label_name": "ReliOn Premier Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317700100",
      "ndc_label_name": "ReliOn Prime Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317700050",
      "ndc_label_name": "ReliOn Prime Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317700025",
      "ndc_label_name": "ReliOn Prime Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146101",
      "ndc_label_name": "ReliOn True Metrix Test Strips Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146104",
      "ndc_label_name": "ReliOn True Metrix Test Strips Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66004603105",
      "ndc_label_name": "ReliOn Ultima Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66004602909",
      "ndc_label_name": "ReliOn Ultima Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742002644",
      "ndc_label_name": "ReliOn Ultra Thin Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38396045402",
      "ndc_label_name": "ReliOn Ultra Thin Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742026442",
      "ndc_label_name": "ReliOn Ultra Thin Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00143939101",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072306",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072303",
      "ndc_label_name": "Remifentanil HCl SOLUTION RECONSTITUTED 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072304",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939110",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072301",
      "ndc_label_name": "Remifentanil HCl SOLUTION RECONSTITUTED 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939201",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939210",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072405",
      "ndc_label_name": "Remifentanil HCl SOLUTION RECONSTITUTED 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072401",
      "ndc_label_name": "Remifentanil HCl SOLUTION RECONSTITUTED 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939301",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143939310",
      "ndc_label_name": "Remifentanil HCl Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072501",
      "ndc_label_name": "Remifentanil HCl SOLUTION RECONSTITUTED 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072510",
      "ndc_label_name": "Remifentanil HCl SOLUTION RECONSTITUTED 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66302010501",
      "ndc_label_name": "Remodulin Solution 100 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66302010101",
      "ndc_label_name": "Remodulin Solution 20 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66302011001",
      "ndc_label_name": "Remodulin Solution 200 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66302010201",
      "ndc_label_name": "Remodulin Solution 50 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66302011401",
      "ndc_label_name": "Remodulin Solution 8 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50486008252",
      "ndc_label_name": "Replacement Air Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008296",
      "ndc_label_name": "Replacement Air Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373092904",
      "ndc_label_name": "Replacement Filters",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "38673005502",
      "ndc_label_name": "Replacement Filters",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490041086",
      "ndc_label_name": "Replacement Filters",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08567529974",
      "ndc_label_name": "Restore Hydrogel Dressing Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "04351044010",
      "ndc_label_name": "Reusable Comfortseal Mask-LRG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351024010",
      "ndc_label_name": "Reusable Comfortseal Mask-MED",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351034010",
      "ndc_label_name": "Reusable Comfortseal Mask-SML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58151039531",
      "ndc_label_name": "Revatio Solution 10 MG/12.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069033801",
      "ndc_label_name": "Revatio Solution 10 MG/12.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63347012001",
      "ndc_label_name": "RevitaDERM Wound Care Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00562780505",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780500",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780501",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780525",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206030090",
      "ndc_label_name": "Rhophylac Solution Prefilled Syringe 1500 UNIT/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206030001",
      "ndc_label_name": "Rhophylac Solution Prefilled Syringe 1500 UNIT/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206030010",
      "ndc_label_name": "Rhophylac Solution Prefilled Syringe 1500 UNIT/2ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513022401",
      "ndc_label_name": "Riabni Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513032601",
      "ndc_label_name": "Riabni Solution 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833089190",
      "ndc_label_name": "RiaSTAP Solution Reconstituted Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833089151",
      "ndc_label_name": "RiaSTAP SOLUTION RECONSTITUTED Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08539002201",
      "ndc_label_name": "Rightest Alternate Site Adapt",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539001201",
      "ndc_label_name": "Rightest GC300 Control Liquid High In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08539001301",
      "ndc_label_name": "Rightest GC300 Control Liquid Normal In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08539002001",
      "ndc_label_name": "Rightest GD500 Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539060000",
      "ndc_label_name": "Rightest GL300 Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539105002",
      "ndc_label_name": "Rightest GS100 Blood Glucose STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539000501",
      "ndc_label_name": "Rightest GS300 Blood Glucose STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539505003",
      "ndc_label_name": "Rightest GS550 Blood Glucose STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539392502",
      "ndc_label_name": "Rightest GT333 Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539392101",
      "ndc_label_name": "Rightest GT333 Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08539392203",
      "ndc_label_name": "Rightest GT333 Glucose Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00338010504",
      "ndc_label_name": "Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264778000",
      "ndc_label_name": "Ringers SOLUTION Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798209",
      "ndc_label_name": "Ringers Solution Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08591601001",
      "ndc_label_name": "RiteFlo DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242010801",
      "ndc_label_name": "Rituxan Hycela SOLUTION 1400-23400 MG -UT/11.7ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242010901",
      "ndc_label_name": "Rituxan Hycela SOLUTION 1600-26800 MG -UT/13.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242005121",
      "ndc_label_name": "Rituxan Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242005306",
      "ndc_label_name": "Rituxan Solution 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219006502",
      "ndc_label_name": "Rocuronium Bromide +RFID Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219069501",
      "ndc_label_name": "Rocuronium Bromide +RFID Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219069505",
      "ndc_label_name": "Rocuronium Bromide +RFID Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219006505",
      "ndc_label_name": "Rocuronium Bromide +RFID Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013010",
      "ndc_label_name": "Rocuronium Bromide Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013001",
      "ndc_label_name": "Rocuronium Bromide Solution 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409703701",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822420006",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409516010",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925110",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322092",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547053110",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925101",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322070",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409703710",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042601",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042610",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409516001",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068710",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756067010",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409955810",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748034902",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822420005",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013101",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044410",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021066210",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547053101",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071891",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409955831",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839014210",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001310",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145013110",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409955850",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071810",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022899",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022941",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150022610",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611075710",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044404",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748034901",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022902",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071811",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860065110",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022810",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071892",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860065142",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839014201",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572065110",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572065101",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611075701",
      "ndc_label_name": "Rocuronium Bromide Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409955805",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021066205",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409140310",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925001",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409140305",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547053001",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318910",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143925010",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042612",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066000710",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068705",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044202",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409318905",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547053010",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022800",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409955811",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457022805",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150022505",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756066910",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288070092",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409955849",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748034801",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860065105",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322075",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748034802",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042602",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288070091",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822420002",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322095",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860065141",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81565020402",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042605",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822420001",
      "ndc_label_name": "Rocuronium Bromide SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219044205",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323042615",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022841",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839014110",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288070005",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572065001",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288070006",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572065010",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71839014101",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611075601",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162226302",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611075610",
      "ndc_label_name": "Rocuronium Bromide Solution 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264571101",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63037015525",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374092405",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266200209",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264571110",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65302051005",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004085009",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266900505",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092107344",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70004085028",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266200201",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449000411",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092145244",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449005911",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177015902",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71286601001",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72196601001",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73702012915",
      "ndc_label_name": "Rocuronium Bromide Solution Prefilled Syringe 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703400401",
      "ndc_label_name": "romiDEPsin Solution 27.5 MG/5.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121225001",
      "ndc_label_name": "romiDEPsin Solution 27.5 MG/5.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323092517",
      "ndc_label_name": "romiDEPsin Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323092688",
      "ndc_label_name": "romiDEPsin Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409930321",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073710",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409930320",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066002710",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781314214",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926601",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066002701",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926610",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145011001",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006725",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145011010",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021925",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150020120",
      "ndc_label_name": "Ropivacaine HCl SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150020010",
      "ndc_label_name": "Ropivacaine HCl SOLUTION 10 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079520",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006710",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073711",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021901",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073821",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073820",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079555",
      "ndc_label_name": "Ropivacaine HCl Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143919612",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143919501",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926310",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409930021",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143919524",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067167",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016610",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926301",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066015201",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067182",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409930020",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066015210",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143919601",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067187",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512079724",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067166",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145010701",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066015410",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478008290",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063204",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478008292",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066015401",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073321",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001501",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063220",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019699",
      "ndc_label_name": "Ropivacaine HCl SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145010710",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457079899",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001510",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019520",
      "ndc_label_name": "Ropivacaine HCl SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462077735",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016501",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457079999",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457079920",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006210",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079355",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016510",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457079810",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006125",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063202",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016601",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512079701",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063210",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079374",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462077710",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121173309",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073320",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006110",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021625",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021601",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006225",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512079801",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121173209",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512079824",
      "ndc_label_name": "ROPivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073210",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073211",
      "ndc_label_name": "Ropivacaine HCl Solution 2 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006401",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021065282",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462077855",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143919701",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143919724",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926410",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066002301",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021065287",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485051901",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079462",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006325",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926401",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001901",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478008130",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066002310",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019720",
      "ndc_label_name": "Ropivacaine HCl SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021701",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079484",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019830",
      "ndc_label_name": "Ropivacaine HCl SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781314030",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021725",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066001910",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145010801",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145010901",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006425",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006410",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121173403",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069006301",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145010810",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145010910",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572070701",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073420",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073421",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462077874",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073531",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485051910",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021825",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073530",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603021801",
      "ndc_label_name": "ROPivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572070710",
      "ndc_label_name": "Ropivacaine HCl Solution 5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926501",
      "ndc_label_name": "ROPivacaine HCl Solution 7.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073621",
      "ndc_label_name": "ROPivacaine HCl Solution 7.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926510",
      "ndc_label_name": "ROPivacaine HCl Solution 7.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288073620",
      "ndc_label_name": "ROPivacaine HCl Solution 7.5 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150019920",
      "ndc_label_name": "Ropivacaine HCl SOLUTION 7.5 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069023801",
      "ndc_label_name": "Ruxience Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069024901",
      "ndc_label_name": "Ruxience Solution 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894051001",
      "ndc_label_name": "Rybrevant Faspro Solution 1600-20000 MG-UT/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894051401",
      "ndc_label_name": "Rybrevant Faspro Solution 2240-28000 MG-UT/14ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894051501",
      "ndc_label_name": "Rybrevant Faspro Solution 2400-30000 MG-UT/15ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894052201",
      "ndc_label_name": "Rybrevant Faspro Solution 3520-44000 MG-UT/22ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894050101",
      "ndc_label_name": "Rybrevant Solution 350 MG/7ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727090003",
      "ndc_label_name": "Rylaze Solution 10 MG/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727090001",
      "ndc_label_name": "Rylaze Solution 10 MG/0.5ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82959011101",
      "ndc_label_name": "Rytelo Solution Reconstituted 188 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82959011201",
      "ndc_label_name": "Rytelo Solution Reconstituted 47 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60003012556",
      "ndc_label_name": "Safety Lancet 30G/Pressure Act",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08463803028",
      "ndc_label_name": "Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470101501",
      "ndc_label_name": "Safety Lancets 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000189",
      "ndc_label_name": "Safety Lancets 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000190",
      "ndc_label_name": "Safety Lancets 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399904801",
      "ndc_label_name": "Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000631",
      "ndc_label_name": "Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94046000191",
      "ndc_label_name": "Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739015110",
      "ndc_label_name": "Safety Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08373312800",
      "ndc_label_name": "Sami the Seal Filters",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000176",
      "ndc_label_name": "SAPS care Alcohol Prep PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60000052658",
      "ndc_label_name": "SAPS Health Alcohol Prep Pad",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000715",
      "ndc_label_name": "SAPS health Alcohol Prep PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000733",
      "ndc_label_name": "SAPS Health Care Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049446",
      "ndc_label_name": "SAPS Health Plus Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000716",
      "ndc_label_name": "SAPS health Twist Top Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50632000732",
      "ndc_label_name": "SAPS Twist Top Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91237000175",
      "ndc_label_name": "SAPScare Twist Top Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00024067401",
      "ndc_label_name": "Sarclisa Escena Solution 1400 MG/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024065401",
      "ndc_label_name": "Sarclisa Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024065601",
      "ndc_label_name": "Sarclisa Solution 500 MG/25ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15127000887",
      "ndc_label_name": "SB Alcohol Prep PAD 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127040205",
      "ndc_label_name": "SB Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127040105",
      "ndc_label_name": "SB Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127040101",
      "ndc_label_name": "SB Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127040305",
      "ndc_label_name": "SB Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127001145",
      "ndc_label_name": "SB Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127040301",
      "ndc_label_name": "SB Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127099020",
      "ndc_label_name": "SB Lancets Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "15127099010",
      "ndc_label_name": "SB Lancets Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "15127099110",
      "ndc_label_name": "SB Lancets Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "15127099120",
      "ndc_label_name": "SB Lancets Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784089013",
      "ndc_label_name": "SecureSafe Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784089012",
      "ndc_label_name": "SecureSafe Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784089042",
      "ndc_label_name": "SecureSafe Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784089043",
      "ndc_label_name": "SecureSafe Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40117035008",
      "ndc_label_name": "SecureSafe Safety Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40117035007",
      "ndc_label_name": "SecureSafe Safety Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317661201",
      "ndc_label_name": "Select-Lite Device/Lancets KIT",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317660001",
      "ndc_label_name": "Select-Lite Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071122",
      "ndc_label_name": "SensiLance Safety Lancets 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071222",
      "ndc_label_name": "SensiLance Safety Lancets 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071223",
      "ndc_label_name": "SensiLance Safety Lancets 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071123",
      "ndc_label_name": "SensiLance Safety Lancets 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071242",
      "ndc_label_name": "SensiLance Safety Lancets 26G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071143",
      "ndc_label_name": "SensiLance Safety Lancets 26G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071142",
      "ndc_label_name": "SensiLance Safety Lancets 26G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071243",
      "ndc_label_name": "SensiLance Safety Lancets 26G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071253",
      "ndc_label_name": "SensiLance Safety Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071153",
      "ndc_label_name": "SensiLance Safety Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071152",
      "ndc_label_name": "SensiLance Safety Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784071252",
      "ndc_label_name": "SensiLance Safety Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63323046557",
      "ndc_label_name": "Sensorcaine SOLUTION 0.25 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046501",
      "ndc_label_name": "Sensorcaine Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046701",
      "ndc_label_name": "Sensorcaine Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046757",
      "ndc_label_name": "Sensorcaine SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046401",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046408",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046437",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.25 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046417",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.25 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046431",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.25 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046402",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046438",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046439",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046409",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.25 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046609",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046608",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046639",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046601",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046603",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046617",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046631",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046638",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046637",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047201",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.75 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047237",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.75 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047217",
      "ndc_label_name": "Sensorcaine-MPF SOLUTION 0.75 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047203",
      "ndc_label_name": "Sensorcaine-MPF Solution 0.75 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046802",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.25% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046817",
      "ndc_label_name": "Sensorcaine-MPF/Epinephrine SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046801",
      "ndc_label_name": "Sensorcaine-MPF/Epinephrine Solution 0.25% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046837",
      "ndc_label_name": "Sensorcaine-MPF/Epinephrine SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046238",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046217",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046203",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046231",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046204",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046201",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046237",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046037",
      "ndc_label_name": "Sensorcaine-MPF/Epinephrine SOLUTION 0.75-1:200000 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046001",
      "ndc_label_name": "Sensorcaine-MPF/EPINEPHrine Solution 0.75-1:200000 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046101",
      "ndc_label_name": "Sensorcaine/EPINEPHrine Solution 0.25% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046157",
      "ndc_label_name": "Sensorcaine/Epinephrine SOLUTION 0.25% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046301",
      "ndc_label_name": "Sensorcaine/EPINEPHrine Solution 0.5% -1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046357",
      "ndc_label_name": "Sensorcaine/Epinephrine SOLUTION 0.5% -1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162224502",
      "ndc_label_name": "Sevoflurane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794002225",
      "ndc_label_name": "Sevoflurane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781616043",
      "ndc_label_name": "Sevoflurane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019065164",
      "ndc_label_name": "Sevoflurane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301007001",
      "ndc_label_name": "Sevoflurane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019065364",
      "ndc_label_name": "Sevoflurane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527612374",
      "ndc_label_name": "Sevoflurane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781616086",
      "ndc_label_name": "Sevoflurane SOLUTION Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794001525",
      "ndc_label_name": "Sevoflurane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12164000525",
      "ndc_label_name": "Sevoflurane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084943",
      "ndc_label_name": "Shingrix Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791900",
      "ndc_label_name": "Shingrix Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58160084952",
      "ndc_label_name": "Shingrix Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373025531",
      "ndc_label_name": "Sidestream Adult Face Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373616000",
      "ndc_label_name": "Sidestream Adult Face Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373252100",
      "ndc_label_name": "Sidestream Adult Face Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373438200",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373552900",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373043461",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373346100",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373052521",
      "ndc_label_name": "Sidestream Pls Adult Face Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55150016613",
      "ndc_label_name": "Sildenafil Citrate SOLUTION 10 MG/12.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462426003",
      "ndc_label_name": "Silicone Mask/Adult",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426013",
      "ndc_label_name": "Silicone Mask/Adult",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426011",
      "ndc_label_name": "Silicone Mask/Infant",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426001",
      "ndc_label_name": "Silicone Mask/Infant",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426002",
      "ndc_label_name": "Silicone Mask/Pediatric",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426012",
      "ndc_label_name": "Silicone Mask/Pediatric",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "98302000122",
      "ndc_label_name": "Simple Diagnostics Lancing Dev",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98302000100",
      "ndc_label_name": "Simple Diagnostics Lancing Dev",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63000056502",
      "ndc_label_name": "Simplera Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000082957",
      "ndc_label_name": "Simplera Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000095640",
      "ndc_label_name": "Simplera Sync Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000095638",
      "ndc_label_name": "Simplera Sync Sensor",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000056504",
      "ndc_label_name": "Simplera System",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63000082965",
      "ndc_label_name": "Simplera System",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72266024801",
      "ndc_label_name": "Sincalide Solution Reconstituted 5 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323057905",
      "ndc_label_name": "Sincalide Solution Reconstituted 5 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266024805",
      "ndc_label_name": "Sincalide Solution Reconstituted 5 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323057901",
      "ndc_label_name": "Sincalide Solution Reconstituted 5 MCG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00193656831",
      "ndc_label_name": "Single-Let",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10599000301",
      "ndc_label_name": "Sinuva IMPLANT 1350 MCG Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08522000050",
      "ndc_label_name": "Smart Diabetes Vantage Lancing",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08524000103",
      "ndc_label_name": "Smartest Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08524000201",
      "ndc_label_name": "Smartest Control Medium SOLUTION IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08524000403",
      "ndc_label_name": "Smartest Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63323082010",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082005",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082001",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082000",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082050",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082003",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082074",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323082004",
      "ndc_label_name": "SMOFlipid Emulsion 20 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329905",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830243601",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329916",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329906",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329915",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409729973",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409729945",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329945",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329925",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784023110",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329926",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409729983",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409329946",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409729925",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784023010",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784023020",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784023120",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641626101",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71357000201",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71357000701",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641626201",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784022910",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069004701",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71357000810",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71357000710",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830243701",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71357000210",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830243702",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069004725",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71357000801",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830243602",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069004801",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069004820",
      "ndc_label_name": "Sodium Acetate Solution 2 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517502325",
      "ndc_label_name": "Sodium Acetate Solution 4 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323003200",
      "ndc_label_name": "Sodium Acetate Solution 4 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784023210",
      "ndc_label_name": "Sodium Acetate Solution 4 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323003204",
      "ndc_label_name": "Sodium Acetate Solution 4 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784023201",
      "ndc_label_name": "Sodium Acetate Solution 4 MEQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409555502",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409553414",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409553424",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754501201",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323008303",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409555512",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409555501",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754501204",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323008305",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409555511",
      "ndc_label_name": "Sodium Bicarbonate Solution 4.2 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409490014",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409662530",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409662535",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409663724",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409662514",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409662522",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090681300",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409490024",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409663714",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754501101",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020901",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754500104",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754500101",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754888801",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754802001",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754501104",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090053000",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754888804",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627243001",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162231404",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462095165",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092101550",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754802004",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323008925",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754500105",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462095150",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374091450",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572074001",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095005003",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81665020025",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162231402",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298762003",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323008950",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572074020",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572074025",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329335201",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572020020",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020925",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374021450",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81665020005",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81298762001",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095005001",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449001140",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572020001",
      "ndc_label_name": "Sodium Bicarbonate Solution 8.4 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00223172002",
      "ndc_label_name": "Sodium Bicarbonate TABLET 325 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223172001",
      "ndc_label_name": "Sodium Bicarbonate TABLET 325 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536104610",
      "ndc_label_name": "Sodium Bicarbonate TABLET 325 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861008010",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70369000201",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135068410",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738003503",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004153",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223172102",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135068510",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004160",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223172101",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904726161",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004180",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24689013701",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038185",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016280",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004185",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016253",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536104710",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016260",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016270",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016285",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043894",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "64980029410",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861008110",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038160",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038170",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016294",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038153",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090302100",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333082710",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66553000801",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "64980052810",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038194",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038180",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367025810",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043860",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629877501",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333082725",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618003410",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043853",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738002003",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610044553",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610066953",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333082925",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610066960",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043870",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70369000101",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610044560",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043880",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610044580",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610066980",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333082910",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333083110",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333083125",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00338004804",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004727",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264220110",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264220100",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004729",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990713836",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264738850",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004746",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004805",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338005047",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004744",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004803",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011004",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219050603",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264738860",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004802",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990613822",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011001",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004747",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338005144",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990797207",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990713809",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990613803",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219050630",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219050402",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57896000210",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990797205",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57896000225",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990797208",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219050420",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517730525",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088406",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088401",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517730501",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017005",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145020001",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145020025",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072825",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072805",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572030925",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572030901",
      "ndc_label_name": "Sodium Phosphates Solution 15 MMOLE/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145020201",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088601",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145020225",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517735001",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517735025",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088656",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462073025",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462073050",
      "ndc_label_name": "Sodium Phosphates Solution 150 MMOLE/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088116",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072915",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017015",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409739182",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145020125",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072925",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409739172",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323088101",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517731501",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145020101",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517731525",
      "ndc_label_name": "Sodium Phosphates Solution 45 MMOLE/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40565011527",
      "ndc_label_name": "Solosite Wound Gel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08611506001",
      "ndc_label_name": "Solus V2 Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08611506101",
      "ndc_label_name": "Solus V2 Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08611504100",
      "ndc_label_name": "Solus V2 Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08611505001",
      "ndc_label_name": "Solus V2 Lancing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08611503050",
      "ndc_label_name": "Solus V2 Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08611504000",
      "ndc_label_name": "Solus V2 Twist Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001144",
      "ndc_label_name": "SootheNeb NBL 100 Adult Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001145",
      "ndc_label_name": "SootheNeb NBL 100 Child Mask",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001147",
      "ndc_label_name": "SootheNeb NBL 100 Med Cup",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001146",
      "ndc_label_name": "SootheNeb NBL 100 Mesh Cap",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80777011309",
      "ndc_label_name": "Spikevax 6m-11y Suspension Prefilled Syringe 25 MCG/0.25ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777011380",
      "ndc_label_name": "Spikevax 6m-11y Suspension Prefilled Syringe 25 MCG/0.25ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777011387",
      "ndc_label_name": "Spikevax 6m-11y Suspension Prefilled Syringe 25 MCG/0.25ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777011201",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777011093",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777011096",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777010201",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777011296",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777010293",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777010296",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777011288",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57845000601",
      "ndc_label_name": "Spiro PD DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458002802",
      "ndc_label_name": "Spravato (56 MG Dose) Solution Therapy Pack 28 MG/DEVICE Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50458002803",
      "ndc_label_name": "Spravato (84 MG Dose) Solution Therapy Pack 28 MG/DEVICE Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66259014601",
      "ndc_label_name": "Spy Agent Green Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66259093615",
      "ndc_label_name": "Spy- MIS Kit Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66259090314",
      "ndc_label_name": "SPY-PHI Kit Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66259090324",
      "ndc_label_name": "SPY-PHI Kit Solution Reconstituted 25 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08565015915",
      "ndc_label_name": "SteriLance TL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08565016915",
      "ndc_label_name": "SteriLance TL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08565017915",
      "ndc_label_name": "SteriLance TL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45713009503",
      "ndc_label_name": "Stimulen Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45713069506",
      "ndc_label_name": "Stimulen Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45713009502",
      "ndc_label_name": "Stimulen Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73661042220",
      "ndc_label_name": "Strata grt Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722098110",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933801",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789010405",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991096425",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933825",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323094310",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598066611",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789010407",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722098131",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729049345",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023242",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070003",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067710",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323094321",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070002",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794023202",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54879003725",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598066625",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070011",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070010",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54879003750",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374030010",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710137701",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070026",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374030005",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991096499",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070004",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069030110",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121158101",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043002101",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070012",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071910",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070025",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918070027",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710137702",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071911",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043002191",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071991",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069030125",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834015125",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069078310",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069078325",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121158105",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288071992",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834015102",
      "ndc_label_name": "Succinylcholine Chloride Solution 20 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73702013415",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641623410",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641623401",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298040118",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066012705",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449000511",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066012701",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298040105",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298040106",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066012901",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449000515",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83298040119",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066012905",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449012615",
      "ndc_label_name": "Succinylcholine Chloride Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219027401",
      "ndc_label_name": "Succinylcholine Cl +RFID Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219027405",
      "ndc_label_name": "Succinylcholine Cl +RFID Solution Prefilled Syringe 100 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219027601",
      "ndc_label_name": "Succinylcholine Cl +RFID Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219027610",
      "ndc_label_name": "Succinylcholine Cl +RFID Solution Prefilled Syringe 200 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409338221",
      "ndc_label_name": "SUFentanil Citrate Solution 50 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409338211",
      "ndc_label_name": "SUFentanil Citrate Solution 50 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611010",
      "ndc_label_name": "SUFentanil Citrate Solution 50 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611001",
      "ndc_label_name": "SUFentanil Citrate Solution 50 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478005001",
      "ndc_label_name": "SUFentanil Citrate Solution 50 MCG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917001648",
      "ndc_label_name": "Super Thin Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10019064634",
      "ndc_label_name": "Suprane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019064434",
      "ndc_label_name": "Suprane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019064164",
      "ndc_label_name": "Suprane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10019064134",
      "ndc_label_name": "Suprane Solution Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08317882501",
      "ndc_label_name": "Supreme II High/Low Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317885050",
      "ndc_label_name": "Supreme Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227012205",
      "ndc_label_name": "Sure Comfort Alcohol Prep PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227012605",
      "ndc_label_name": "Sure Comfort Alcohol Prep Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227080055",
      "ndc_label_name": "Sure Comfort Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227080105",
      "ndc_label_name": "Sure Comfort Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227090035",
      "ndc_label_name": "Sure Comfort Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090627200",
      "ndc_label_name": "Sure Comfort Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227090055",
      "ndc_label_name": "Sure Comfort Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227090105",
      "ndc_label_name": "Sure Comfort Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227062035",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090627000",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227062055",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090627400",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090627100",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227062105",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090628400",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227070055",
      "ndc_label_name": "Sure Comfort Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227065035",
      "ndc_label_name": "Sure Comfort Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090627500",
      "ndc_label_name": "Sure Comfort Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227065045",
      "ndc_label_name": "Sure Comfort Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227065055",
      "ndc_label_name": "Sure Comfort Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090626900",
      "ndc_label_name": "Sure Comfort Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227065105",
      "ndc_label_name": "Sure Comfort Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090628300",
      "ndc_label_name": "Sure Comfort Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227001810",
      "ndc_label_name": "Sure Comfort Lancets 18G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227002110",
      "ndc_label_name": "Sure Comfort Lancets 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227002310",
      "ndc_label_name": "Sure Comfort Lancets 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227028105",
      "ndc_label_name": "Sure Comfort Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227030105",
      "ndc_label_name": "Sure Comfort Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227003011",
      "ndc_label_name": "Sure Comfort Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227052205",
      "ndc_label_name": "Sure Comfort Lancing Pen",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227010105",
      "ndc_label_name": "Sure Comfort Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227012105",
      "ndc_label_name": "Sure Comfort Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227012125",
      "ndc_label_name": "Sure Comfort Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227012155",
      "ndc_label_name": "Sure Comfort Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227012175",
      "ndc_label_name": "Sure Comfort Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227074015",
      "ndc_label_name": "Sure Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227013025",
      "ndc_label_name": "Sure Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227013085",
      "ndc_label_name": "Sure Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86227013055",
      "ndc_label_name": "Sure Comfort Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94542005005",
      "ndc_label_name": "Surelite Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94542051150",
      "ndc_label_name": "Surelite Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00074104004",
      "ndc_label_name": "Survanta SUSPENSION 25-0.9 MG/ML-% Intratracheal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074104008",
      "ndc_label_name": "Survanta SUSPENSION 25-0.9 MG/ML-% Intratracheal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242007812",
      "ndc_label_name": "Susvimo (Implant Refill) Solution 10 MG/0.1ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16784069943",
      "ndc_label_name": "Syringe Luer Slip 25G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "86227071585",
      "ndc_label_name": "Syringe Luer Slip 25G X 5/8\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "14789013507",
      "ndc_label_name": "Tacrolimus Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789013505",
      "ndc_label_name": "Tacrolimus Solution 5 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "98302000103",
      "ndc_label_name": "Tai Doc Control SOLUTION Normal IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57894046901",
      "ndc_label_name": "Talvey Solution 3 MG/1.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894047001",
      "ndc_label_name": "Talvey Solution 40 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002122001",
      "ndc_label_name": "Tauvid Solution 300-3700 MBQ/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242093301",
      "ndc_label_name": "Tecentriq Hybreza Solution 1875-30000 MG-UT/15ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242091701",
      "ndc_label_name": "Tecentriq Solution 1200 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242091801",
      "ndc_label_name": "Tecentriq Solution 840 MG/14ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08317880300",
      "ndc_label_name": "TechLite AST Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260305",
      "ndc_label_name": "TechLITE Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317260314",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317260315",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260316",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260311",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260312",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317260313",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317880128",
      "ndc_label_name": "TechLite Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317880228",
      "ndc_label_name": "TechLite Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317880125",
      "ndc_label_name": "TechLite Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317880225",
      "ndc_label_name": "TechLite Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317880126",
      "ndc_label_name": "TechLite Lancets 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317235931",
      "ndc_label_name": "TechLite Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317235131",
      "ndc_label_name": "TechLite Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317238931",
      "ndc_label_name": "TechLite Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317238131",
      "ndc_label_name": "TechLite Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317234132",
      "ndc_label_name": "TechLite Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317234932",
      "ndc_label_name": "TechLite Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317236132",
      "ndc_label_name": "TechLite Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317234232",
      "ndc_label_name": "TechLite Plus Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11994009012",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009005",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009001",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009003",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009007",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009010",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009092",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009006",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009036",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009073",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009004",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009009",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994009011",
      "ndc_label_name": "TechneLite Kit Combination",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45567055502",
      "ndc_label_name": "Technetium Tc 99m Sestamibi Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45567055501",
      "ndc_label_name": "Technetium Tc 99m Sestamibi Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994000320",
      "ndc_label_name": "Technetium Tc 99m Sestamibi Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65857050020",
      "ndc_label_name": "Technetium Tc 99m Sestamibi Kit Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894045001",
      "ndc_label_name": "Tecvayli Solution 153 MG/1.7ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894044901",
      "ndc_label_name": "Tecvayli Solution 30 MG/3ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085138101",
      "ndc_label_name": "Temodar SOLUTION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611078001",
      "ndc_label_name": "Temsirolimus Solution 25 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611078502",
      "ndc_label_name": "Temsirolimus Solution 25 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729022361",
      "ndc_label_name": "Temsirolimus Solution 25 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219020005",
      "ndc_label_name": "Temsirolimus Solution 25 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206200",
      "ndc_label_name": "Tenivac Suspension 5-2 LF/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281021515",
      "ndc_label_name": "Tenivac Suspension 5-2 LF/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281021510",
      "ndc_label_name": "Tenivac Suspension 5-2 LF/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281021558",
      "ndc_label_name": "Tenivac Suspension 5-2 LF/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281021588",
      "ndc_label_name": "Tenivac Suspension 5-2 LF/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121163101",
      "ndc_label_name": "Tepadina Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121163001",
      "ndc_label_name": "Tepadina Solution Reconstituted 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121274901",
      "ndc_label_name": "Tepadina Solution Reconstituted 200 MG/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121168701",
      "ndc_label_name": "Tepadina Solution Reconstituted 400 MG/400ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81927010601",
      "ndc_label_name": "Tepylute Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81927010501",
      "ndc_label_name": "Tepylute Solution 15 MG/1.5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794001910",
      "ndc_label_name": "Terrell SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794001925",
      "ndc_label_name": "Terrell SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72579012101",
      "ndc_label_name": "Tevimbra Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72579012500",
      "ndc_label_name": "Tevimbra Solution 150 MG/15ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409159314",
      "ndc_label_name": "Tham Solution 30 MEQ/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409159304",
      "ndc_label_name": "Tham Solution 30 MEQ/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288015710",
      "ndc_label_name": "Thiotepa Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598017111",
      "ndc_label_name": "Thiotepa Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205004601",
      "ndc_label_name": "Thiotepa Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219002920",
      "ndc_label_name": "Thiotepa Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143929201",
      "ndc_label_name": "Thiotepa Solution Reconstituted 100 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956501",
      "ndc_label_name": "Thiotepa SOLUTION RECONSTITUTED 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021024602",
      "ndc_label_name": "Thiotepa Solution Reconstituted 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288015605",
      "ndc_label_name": "Thiotepa Solution Reconstituted 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143930901",
      "ndc_label_name": "Thiotepa Solution Reconstituted 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54879001413",
      "ndc_label_name": "Thiotepa Solution Reconstituted 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065011",
      "ndc_label_name": "Thiotepa Solution Reconstituted 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205004501",
      "ndc_label_name": "Thiotepa Solution Reconstituted 15 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08373073000",
      "ndc_label_name": "Threshold IMT",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373073500",
      "ndc_label_name": "Threshold PEP Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13533060321",
      "ndc_label_name": "Thrombate III Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533060612",
      "ndc_label_name": "Thrombate III Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533060250",
      "ndc_label_name": "Thrombate III SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533060320",
      "ndc_label_name": "Thrombate III Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793020505",
      "ndc_label_name": "Thrombin-JMI Epistaxis KIT 5000 UNIT EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793021721",
      "ndc_label_name": "Thrombin-JMI KIT 20000 UNIT EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793021722",
      "ndc_label_name": "Thrombin-JMI KIT 20000 UNIT EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070505",
      "ndc_label_name": "Thrombin-JMI KIT 5000 UNIT EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793002005",
      "ndc_label_name": "Thrombin-JMI Solution 20000 UNIT/20ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793002001",
      "ndc_label_name": "Thrombin-JMI Solution 20000 UNIT/20ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793000501",
      "ndc_label_name": "Thrombin-JMI Solution 5000 UNIT/5ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793000505",
      "ndc_label_name": "Thrombin-JMI Solution 5000 UNIT/5ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793021720",
      "ndc_label_name": "Thrombin-JMI SOLUTION RECONSTITUTED 20000 UNIT EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793021505",
      "ndc_label_name": "Thrombin-JMI SOLUTION RECONSTITUTED 5000 UNIT EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468003002",
      "ndc_label_name": "Thyrogen Solution Reconstituted 0.9 MG Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468003001",
      "ndc_label_name": "Thyrogen Solution Reconstituted 0.9 MG Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00052060201",
      "ndc_label_name": "Tice BCG Suspension Reconstituted 50 MG Intravesical",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00052060202",
      "ndc_label_name": "Tice BCG SUSPENSION RECONSTITUTED 50 MG INTRAVESICAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069029702",
      "ndc_label_name": "Ticovac Suspension Prefilled Syringe 1.2 MCG/0.25ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069041102",
      "ndc_label_name": "Ticovac Suspension Prefilled Syringe 2.4 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069041110",
      "ndc_label_name": "Ticovac Suspension Prefilled Syringe 2.4 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789010202",
      "ndc_label_name": "Tirofiban HCl in NaCl Solution 12.5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789010205",
      "ndc_label_name": "Tirofiban HCl in NaCl Solution 12.5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150043001",
      "ndc_label_name": "Tirofiban HCl in NaCl Solution 12.5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789010210",
      "ndc_label_name": "Tirofiban HCl in NaCl Solution 12.5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021041784",
      "ndc_label_name": "Tirofiban HCl in NaCl Solution 12.5-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150042901",
      "ndc_label_name": "Tirofiban HCl in NaCl Solution 5-0.9 MG/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338421210",
      "ndc_label_name": "Tisseel KIT 10 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338430310",
      "ndc_label_name": "Tisseel KIT 10 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338421002",
      "ndc_label_name": "Tisseel KIT 2 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338430102",
      "ndc_label_name": "Tisseel KIT 2 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338430204",
      "ndc_label_name": "Tisseel KIT 4 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338421104",
      "ndc_label_name": "Tisseel KIT 4 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338956001",
      "ndc_label_name": "Tisseel Solution External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338956401",
      "ndc_label_name": "Tisseel Solution External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338956801",
      "ndc_label_name": "Tisseel Solution External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51144000301",
      "ndc_label_name": "Tivdak Solution Reconstituted 40 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242001403",
      "ndc_label_name": "TNKase Kit 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242000901",
      "ndc_label_name": "TNKase Kit 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242012047",
      "ndc_label_name": "TNKase Kit 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242003706",
      "ndc_label_name": "TNKase Kit 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242017601",
      "ndc_label_name": "TNKase Kit 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16169040403",
      "ndc_label_name": "Today Sponge 1000 MG VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214070740",
      "ndc_label_name": "Todays Health Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214030740",
      "ndc_label_name": "Todays Health Short Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214020740",
      "ndc_label_name": "Todays Health Thin Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214025740",
      "ndc_label_name": "Todays Health Thin Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214065740",
      "ndc_label_name": "Todays Health Thin Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16729024331",
      "ndc_label_name": "Topotecan HCl Solution 4 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703471401",
      "ndc_label_name": "Topotecan HCl Solution 4 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409030201",
      "ndc_label_name": "Topotecan HCl Solution 4 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729015131",
      "ndc_label_name": "Topotecan HCl Solution Reconstituted 4 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323076294",
      "ndc_label_name": "Topotecan HCl Solution Reconstituted 4 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963061556",
      "ndc_label_name": "Topotecan HCl Solution Reconstituted 4 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323076210",
      "ndc_label_name": "Topotecan HCl Solution Reconstituted 4 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00008117901",
      "ndc_label_name": "Torisel Solution 25 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409577901",
      "ndc_label_name": "TPN Electrolytes Concentrate Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409577911",
      "ndc_label_name": "TPN Electrolytes Concentrate Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338064404",
      "ndc_label_name": "Travasol SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338064406",
      "ndc_label_name": "Travasol SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338064403",
      "ndc_label_name": "Travasol SOLUTION 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917011828",
      "ndc_label_name": "Travel Lancets Advanced 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00069030801",
      "ndc_label_name": "Trazimera Solution Reconstituted 150 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069030601",
      "ndc_label_name": "Trazimera Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069030501",
      "ndc_label_name": "Trazimera Solution Reconstituted 420 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459039120",
      "ndc_label_name": "Treanda Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459039008",
      "ndc_label_name": "Treanda Solution Reconstituted 25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064711",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342780",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020801",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703068601",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703066601",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020601",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064911",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342080",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703069601",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064811",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020901",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781343080",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342580",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020701",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703067601",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064611",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73352052001",
      "ndc_label_name": "Tridergel Gel 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00078089778",
      "ndc_label_name": "Triesence Suspension 40 MG/ML Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82667080001",
      "ndc_label_name": "Triesence Suspension 40 MG/ML Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065054301",
      "ndc_label_name": "Triesence Suspension 40 MG/ML Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459060111",
      "ndc_label_name": "Trisenox Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459060106",
      "ndc_label_name": "Trisenox Solution 12 MG/6ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55135013201",
      "ndc_label_name": "Trodelvy Solution Reconstituted 180 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22600099965",
      "ndc_label_name": "Trojan Bareskin Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600099853",
      "ndc_label_name": "Trojan Bareskin Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600092050",
      "ndc_label_name": "Trojan Enz",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600064203",
      "ndc_label_name": "Trojan Magnum",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600094050",
      "ndc_label_name": "Trojan Ultra Ribbed Lubricated Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600092620",
      "ndc_label_name": "Trojan Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600092720",
      "ndc_label_name": "Trojan Ultra Thin/Spermicidal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600093050",
      "ndc_label_name": "Trojan-Enz Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22600093150",
      "ndc_label_name": "Trojan-Enz/Spermicidal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71357000106",
      "ndc_label_name": "Tromethamine Solution 30 MEQ/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264803110",
      "ndc_label_name": "Tromethamine Solution 30 MEQ/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71357000101",
      "ndc_label_name": "Tromethamine Solution 30 MEQ/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71285808602",
      "ndc_label_name": "Tromethamine Solution 30 MEQ/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264193310",
      "ndc_label_name": "TrophAmine Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264934155",
      "ndc_label_name": "TrophAmine Solution 10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60000052651",
      "ndc_label_name": "True Comfort Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049486",
      "ndc_label_name": "True Comfort Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049487",
      "ndc_label_name": "True Comfort Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049488",
      "ndc_label_name": "True Comfort Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60000052655",
      "ndc_label_name": "True Comfort Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049490",
      "ndc_label_name": "True Comfort Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60000052656",
      "ndc_label_name": "True Comfort Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049491",
      "ndc_label_name": "True Comfort Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60000052654",
      "ndc_label_name": "True Comfort Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049443",
      "ndc_label_name": "True Comfort Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50058086401",
      "ndc_label_name": "True Comfort Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049444",
      "ndc_label_name": "True Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50058086400",
      "ndc_label_name": "True Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60000052652",
      "ndc_label_name": "True Comfort Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049412",
      "ndc_label_name": "True Comfort Pro Alcohol Prep Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049417",
      "ndc_label_name": "True Comfort Pro Insulin Syr 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049418",
      "ndc_label_name": "True Comfort Pro Insulin Syr 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049416",
      "ndc_label_name": "True Comfort Pro Insulin Syr 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049410",
      "ndc_label_name": "True Comfort Pro Insulin Syr 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049409",
      "ndc_label_name": "True Comfort Pro Insulin Syr 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049407",
      "ndc_label_name": "True Comfort Pro Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50071076511",
      "ndc_label_name": "True Comfort Pro Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049400",
      "ndc_label_name": "True Comfort Pro Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50071076513",
      "ndc_label_name": "True Comfort Pro Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50058086410",
      "ndc_label_name": "True Comfort Pro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50071076510",
      "ndc_label_name": "True Comfort Pro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049406",
      "ndc_label_name": "True Comfort Pro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049402",
      "ndc_label_name": "True Comfort Pro Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60006037784",
      "ndc_label_name": "True Comfort Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60006037785",
      "ndc_label_name": "True Comfort Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50058086429",
      "ndc_label_name": "True Comfort Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60015063550",
      "ndc_label_name": "True Comfort Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50071076502",
      "ndc_label_name": "True Comfort Safety Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50071076501",
      "ndc_label_name": "True Comfort Safety Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049413",
      "ndc_label_name": "True Comfort Twist Top Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60000052650",
      "ndc_label_name": "True Comfort Twist Top Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83035911208",
      "ndc_label_name": "True Cover Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83035911201",
      "ndc_label_name": "True Cover Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917018808",
      "ndc_label_name": "True Focus Blood Glucose Strip STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090355900",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016690",
      "ndc_label_name": "True Metrix Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146005",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146001",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090240000",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146003",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08528146404",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146401",
      "ndc_label_name": "True Metrix Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146004",
      "ndc_label_name": "True Metrix Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295014204",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146304",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090246900",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151145001",
      "ndc_label_name": "True Metrix Level 1 Solution Low In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151145002",
      "ndc_label_name": "True Metrix Level 2 Solution Normal In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151145003",
      "ndc_label_name": "True Metrix Level 3 Solution High In Vitro",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151146601",
      "ndc_label_name": "True Metrix Pro Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146604",
      "ndc_label_name": "True Metrix Pro Blood Glucose Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151014201",
      "ndc_label_name": "TRUEdraw Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151212205",
      "ndc_label_name": "Trueness Blood Glucose Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151211001",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151211101",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151211301",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151211401",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151170201",
      "ndc_label_name": "TRUEplus Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151170301",
      "ndc_label_name": "TRUEplus Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151171101",
      "ndc_label_name": "TRUEplus Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151171201",
      "ndc_label_name": "TRUEplus Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151171301",
      "ndc_label_name": "TRUEplus Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151172201",
      "ndc_label_name": "TRUEplus Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151173101",
      "ndc_label_name": "TRUEplus Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151173201",
      "ndc_label_name": "TRUEplus Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151173301",
      "ndc_label_name": "TRUEplus Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151014101",
      "ndc_label_name": "TRUEplus Lancets 26G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151014260",
      "ndc_label_name": "TRUEplus Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013416",
      "ndc_label_name": "TRUEplus Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013415",
      "ndc_label_name": "TRUEplus Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013417",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151014401",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151014402",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151014801",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090355800",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090355801",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013418",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090715900",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090715901",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151014701",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151034002",
      "ndc_label_name": "TRUEplus Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151034025",
      "ndc_label_name": "TRUEplus Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151034001",
      "ndc_label_name": "TRUEplus Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151034125",
      "ndc_label_name": "TRUEplus Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151034101",
      "ndc_label_name": "TRUEplus Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917009960",
      "ndc_label_name": "TRUEtest Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011158",
      "ndc_label_name": "TRUEtest Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917009961",
      "ndc_label_name": "TRUEtest Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917010488",
      "ndc_label_name": "TrueTrack Test STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151085050",
      "ndc_label_name": "TrueTrack Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151081350",
      "ndc_label_name": "TrueTrack Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151081001",
      "ndc_label_name": "TrueTrack Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151082525",
      "ndc_label_name": "TrueTrack Test Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00005010010",
      "ndc_label_name": "Trumenba Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00005010001",
      "ndc_label_name": "Trumenba Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00005010005",
      "ndc_label_name": "Trumenba Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "05632083245",
      "ndc_label_name": "Trustex Color Condoms + Lube",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083240",
      "ndc_label_name": "Trustex Color Condoms + Lube",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083065",
      "ndc_label_name": "Trustex Lub/Ribbed/Studded",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083060",
      "ndc_label_name": "Trustex Lub/Ribbed/Studded",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083067",
      "ndc_label_name": "Trustex Lub/Spermicide Ex St",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083087",
      "ndc_label_name": "Trustex Lub/Spermicide Ex St",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083177",
      "ndc_label_name": "Trustex Lub/Spermicide XL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083197",
      "ndc_label_name": "Trustex Lub/Spermicide XL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084010",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084035",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084015",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084005",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084030",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632088080",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084025",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084020",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084040",
      "ndc_label_name": "Trustex Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083137",
      "ndc_label_name": "Trustex Lubricated Ex Large",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083157",
      "ndc_label_name": "Trustex Lubricated Ex Large",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084240",
      "ndc_label_name": "Trustex Lubricated Extra St",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083047",
      "ndc_label_name": "Trustex Lubricated Extra St",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083027",
      "ndc_label_name": "Trustex Lubricated Extra St",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632088082",
      "ndc_label_name": "Trustex Lubricated/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632098082",
      "ndc_label_name": "Trustex Lubricated/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083220",
      "ndc_label_name": "Trustex Natural Condoms + Lube",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083225",
      "ndc_label_name": "Trustex Natural Condoms + Lube",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084152",
      "ndc_label_name": "Trustex Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084158",
      "ndc_label_name": "Trustex Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084150",
      "ndc_label_name": "Trustex Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084140",
      "ndc_label_name": "Trustex Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084156",
      "ndc_label_name": "Trustex Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632084154",
      "ndc_label_name": "Trustex Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083035",
      "ndc_label_name": "Trustex Ria Lub/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083015",
      "ndc_label_name": "Trustex Ria Lub/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083010",
      "ndc_label_name": "Trustex Ria Lub/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083030",
      "ndc_label_name": "Trustex Ria Lub/Spermicide",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083040",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083025",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083045",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083020",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083050",
      "ndc_label_name": "Trustex Ria Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083055",
      "ndc_label_name": "Trustex Ria Non-Lubricated",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083005",
      "ndc_label_name": "Trustex-Nonoxynol-9/Rib/Stud",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63459010310",
      "ndc_label_name": "Truxima Solution 100 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459010450",
      "ndc_label_name": "Truxima Solution 500 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351096510",
      "ndc_label_name": "TruZone Peak Flow Meter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281075222",
      "ndc_label_name": "Tubersol SOLUTION 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026100",
      "ndc_label_name": "Tubersol Solution 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281075221",
      "ndc_label_name": "Tubersol SOLUTION 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090166800",
      "ndc_label_name": "Tubersol Solution 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281075298",
      "ndc_label_name": "Tubersol SOLUTION 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281075278",
      "ndc_label_name": "Tubersol SOLUTION 5 UNIT/0.1ML Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83490044070",
      "ndc_label_name": "Tubing/Wing Tip",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "98617090400",
      "ndc_label_name": "Twiist Refill Kit Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "98617090100",
      "ndc_label_name": "Twiist Refill Kit/Infusion Set Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "98617010100",
      "ndc_label_name": "Twiist Starter Kit Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164500",
      "ndc_label_name": "Twinrix Suspension Prefilled Syringe 720-20 ELU-MCG/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081552",
      "ndc_label_name": "Twinrix Suspension Prefilled Syringe 720-20 ELU-MCG/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081543",
      "ndc_label_name": "Twinrix Suspension Prefilled Syringe 720-20 ELU-MCG/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50632000786",
      "ndc_label_name": "Twist Top Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00074445651",
      "ndc_label_name": "Ultane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074445604",
      "ndc_label_name": "Ultane SOLUTION INHALATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43820000009",
      "ndc_label_name": "Ulti-Lance Automatic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57515044000",
      "ndc_label_name": "UltiCare Alcohol Swabs PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515044001",
      "ndc_label_name": "UltiCare Alcohol Swabs PAD",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222440006",
      "ndc_label_name": "UltiCare Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222440013",
      "ndc_label_name": "UltiCare Alcohol Swabs PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515003259",
      "ndc_label_name": "UltiCare Insulin Safety Syr 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08222032591",
      "ndc_label_name": "UltiCare Insulin Safety Syr 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08222032195",
      "ndc_label_name": "UltiCare Insulin Safety Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57515003219",
      "ndc_label_name": "UltiCare Insulin Safety Syr 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08222182586",
      "ndc_label_name": "UltiCare Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222082589",
      "ndc_label_name": "UltiCare Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515018258",
      "ndc_label_name": "UltiCare Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222082183",
      "ndc_label_name": "UltiCare Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515018218",
      "ndc_label_name": "UltiCare Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222182180",
      "ndc_label_name": "UltiCare Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515008218",
      "ndc_label_name": "UltiCare Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009239",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222172396",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222092397",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090714500",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515017239",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009259",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222092595",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222192592",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090714600",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090713600",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515019259",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222192196",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009219",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222092199",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515019219",
      "ndc_label_name": "UltiCare Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222073358",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222910035",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222193353",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515007335",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222093356",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515019335",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009335",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515091003",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222193551",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222073556",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222093554",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515091004",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515019355",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222910042",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515007355",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009355",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515091005",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222910059",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222093158",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515019315",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222073150",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222193155",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009315",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515007315",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090713400",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08222173591",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090714300",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222093592",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009359",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515017359",
      "ndc_label_name": "UltiCare Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090714200",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090713300",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08222174390",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08222074393",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08222910004",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08222094391",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57515017439",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57515007439",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57515091000",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57515009439",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08222094599",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222910011",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090714100",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515017459",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222074591",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222174598",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515091001",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090713200",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57515007459",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009459",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222074195",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222094193",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222910028",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009419",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222174192",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515017419",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515091002",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515007419",
      "ndc_label_name": "UltiCare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515002583",
      "ndc_label_name": "UltiCare Micro Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071009",
      "ndc_label_name": "UltiCare Micro Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222025838",
      "ndc_label_name": "UltiCare Micro Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222710093",
      "ndc_label_name": "UltiCare Micro Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222095459",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222142387",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222710031",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515002543",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222025432",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222710079",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222710024",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071002",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071003",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071007",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009545",
      "ndc_label_name": "UltiCare Micro Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222610058",
      "ndc_label_name": "UltiCare Mini Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515061005",
      "ndc_label_name": "UltiCare Mini Pen Needles 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009562",
      "ndc_label_name": "UltiCare Mini Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222095626",
      "ndc_label_name": "UltiCare Mini Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222710147",
      "ndc_label_name": "UltiCare Mini Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071014",
      "ndc_label_name": "UltiCare Mini Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009512",
      "ndc_label_name": "UltiCare Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090624300",
      "ndc_label_name": "UltiCare Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08222095121",
      "ndc_label_name": "UltiCare Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222710062",
      "ndc_label_name": "UltiCare Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090715700",
      "ndc_label_name": "UltiCare Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071006",
      "ndc_label_name": "UltiCare Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071013",
      "ndc_label_name": "UltiCare Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222095534",
      "ndc_label_name": "UltiCare Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222710130",
      "ndc_label_name": "UltiCare Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009553",
      "ndc_label_name": "UltiCare Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222095855",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090271601",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08222710055",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222095831",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222142394",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090485501",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090715001",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090625500",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08222710017",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009583",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090715400",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071001",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090271600",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090715501",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090715000",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090715500",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009585",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515071005",
      "ndc_label_name": "UltiCare Short Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012512",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222125125",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222035530",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222045539",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515003553",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012553",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222125538",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515004553",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515008583",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012583",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222035837",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222125835",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222085832",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515003583",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515009543",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222045430",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515004543",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222085436",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222035431",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222095435",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515008543",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090625600",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222065439",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515003543",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222125439",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012543",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090715300",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222125620",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222045621",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515004562",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012562",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222065620",
      "ndc_label_name": "UltiGuard SafePack Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222123350",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012335",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222123558",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012355",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222123152",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012315",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222124395",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57515012439",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08222124593",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012459",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08222124197",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57515012419",
      "ndc_label_name": "UltiGuard SafePack Syr/Needle 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43820050100",
      "ndc_label_name": "Ultilet Alcohol Swabs PAD",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326281001",
      "ndc_label_name": "Ultilet Classic Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326261001",
      "ndc_label_name": "Ultilet Classic Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326331001",
      "ndc_label_name": "Ultilet Classic Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326281002",
      "ndc_label_name": "Ultilet Classic Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326301001",
      "ndc_label_name": "Ultilet Classic Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326280001",
      "ndc_label_name": "Ultilet Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326330001",
      "ndc_label_name": "Ultilet Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326300001",
      "ndc_label_name": "Ultilet Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326280002",
      "ndc_label_name": "Ultilet Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326290212",
      "ndc_label_name": "Ultilet Pen Needle 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326290012",
      "ndc_label_name": "Ultilet Pen Needle 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326310905",
      "ndc_label_name": "Ultilet Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326310005",
      "ndc_label_name": "Ultilet Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326310008",
      "ndc_label_name": "Ultilet Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326310908",
      "ndc_label_name": "Ultilet Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326320004",
      "ndc_label_name": "Ultilet Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326320904",
      "ndc_label_name": "Ultilet Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08326212201",
      "ndc_label_name": "Ultilet Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326212225",
      "ndc_label_name": "Ultilet Safety Lancets",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08326231001",
      "ndc_label_name": "Ultilet Safety Lancets 23G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67457091201",
      "ndc_label_name": "Ultiva Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003400",
      "ndc_label_name": "Ultiva Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019803",
      "ndc_label_name": "Ultiva Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019800",
      "ndc_label_name": "Ultiva Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003401",
      "ndc_label_name": "Ultiva Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457091200",
      "ndc_label_name": "Ultiva Solution Reconstituted 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457091302",
      "ndc_label_name": "Ultiva Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003500",
      "ndc_label_name": "Ultiva Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019899",
      "ndc_label_name": "Ultiva Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019805",
      "ndc_label_name": "Ultiva Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457091300",
      "ndc_label_name": "Ultiva Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003502",
      "ndc_label_name": "Ultiva Solution Reconstituted 2 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003605",
      "ndc_label_name": "Ultiva Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019898",
      "ndc_label_name": "Ultiva Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72078003600",
      "ndc_label_name": "Ultiva Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457091405",
      "ndc_label_name": "Ultiva Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457019810",
      "ndc_label_name": "Ultiva Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457091400",
      "ndc_label_name": "Ultiva Solution Reconstituted 5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60002035772",
      "ndc_label_name": "Ultra Flo Insulin Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002035773",
      "ndc_label_name": "Ultra Flo Insulin Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002035774",
      "ndc_label_name": "Ultra Flo Insulin Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025933",
      "ndc_label_name": "Ultra Flo Insulin Syr 1/2 Unit 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025945",
      "ndc_label_name": "Ultra Flo Insulin Syr 1/2 Unit 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60002025931",
      "ndc_label_name": "Ultra Flo Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025937",
      "ndc_label_name": "Ultra Flo Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025941",
      "ndc_label_name": "Ultra Flo Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025932",
      "ndc_label_name": "Ultra Flo Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025938",
      "ndc_label_name": "Ultra Flo Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025942",
      "ndc_label_name": "Ultra Flo Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025939",
      "ndc_label_name": "Ultra Flo Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025936",
      "ndc_label_name": "Ultra Flo Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60002025940",
      "ndc_label_name": "Ultra Flo Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60002025944",
      "ndc_label_name": "Ultra Flo Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50027049460",
      "ndc_label_name": "Ultra Neb Accessories Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62850000002",
      "ndc_label_name": "Ultra Thin Lancets 31G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134320801",
      "ndc_label_name": "Ultra Thin Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000101",
      "ndc_label_name": "Ultra-Care Alcohol Prep Pads Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000201",
      "ndc_label_name": "Ultra-Care Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60015063551",
      "ndc_label_name": "Ultra-Care Safety Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51709000729",
      "ndc_label_name": "Ultra-Thin II Auto Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134061802",
      "ndc_label_name": "Ultra-Thin II Ins Syr Short 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134074002",
      "ndc_label_name": "Ultra-Thin II Ins Syr Short 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134074202",
      "ndc_label_name": "Ultra-Thin II Ins Syr Short 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134074402",
      "ndc_label_name": "Ultra-Thin II Ins Syr Short 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134052802",
      "ndc_label_name": "Ultra-Thin II Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134052902",
      "ndc_label_name": "Ultra-Thin II Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134072802",
      "ndc_label_name": "Ultra-Thin II Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134072602",
      "ndc_label_name": "Ultra-Thin II Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89134063102",
      "ndc_label_name": "Ultra-Thin II Mini Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134063002",
      "ndc_label_name": "Ultra-Thin II Pen Needle Short 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89134062202",
      "ndc_label_name": "Ultra-Thin II Pen Needles 29G X 12.7MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000701",
      "ndc_label_name": "Ultracare Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000702",
      "ndc_label_name": "Ultracare Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000704",
      "ndc_label_name": "Ultracare Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000706",
      "ndc_label_name": "Ultracare Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72217000707",
      "ndc_label_name": "Ultracare Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000708",
      "ndc_label_name": "Ultracare Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000602",
      "ndc_label_name": "Ultracare Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000603",
      "ndc_label_name": "Ultracare Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000606",
      "ndc_label_name": "Ultracare Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72217000604",
      "ndc_label_name": "Ultracare Pen Needles 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50419034423",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034405",
      "ndc_label_name": "Ultravist SOLUTION 62 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034421",
      "ndc_label_name": "Ultravist SOLUTION 62 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034458",
      "ndc_label_name": "Ultravist SOLUTION 62 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034705",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034412",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034463",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034410",
      "ndc_label_name": "Ultravist SOLUTION 62 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034464",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034720",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034415",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034422",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034465",
      "ndc_label_name": "Ultravist Solution 62 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034628",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034607",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034821",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034811",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034658",
      "ndc_label_name": "Ultravist SOLUTION 77 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034620",
      "ndc_label_name": "Ultravist SOLUTION 77 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034610",
      "ndc_label_name": "Ultravist SOLUTION 77 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034605",
      "ndc_label_name": "Ultravist SOLUTION 77 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034810",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034662",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034615",
      "ndc_label_name": "Ultravist SOLUTION 77 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034633",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034813",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034627",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034665",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034660",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034663",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034661",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034812",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034805",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419034820",
      "ndc_label_name": "Ultravist Solution 77 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08517065000",
      "ndc_label_name": "Unifine OTC Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517065100",
      "ndc_label_name": "Unifine OTC Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517064100",
      "ndc_label_name": "Unifine OTC Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517064000",
      "ndc_label_name": "Unifine OTC Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470355501",
      "ndc_label_name": "Unifine Pentips 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470115001",
      "ndc_label_name": "Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517055085",
      "ndc_label_name": "Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517055087",
      "ndc_label_name": "Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470285001",
      "ndc_label_name": "Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470205001",
      "ndc_label_name": "Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470355001",
      "ndc_label_name": "Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517055088",
      "ndc_label_name": "Unifine Pentips 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517053088",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517053085",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214353001",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470203001",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470283001",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470353001",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470113001",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517053087",
      "ndc_label_name": "Unifine Pentips 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470114001",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470054041",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470054001",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517054088",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470204001",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517054085",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470354001",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517054087",
      "ndc_label_name": "Unifine Pentips 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470359501",
      "ndc_label_name": "Unifine Pentips 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517059588",
      "ndc_label_name": "Unifine Pentips 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470385501",
      "ndc_label_name": "Unifine Pentips Plus 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470185001",
      "ndc_label_name": "Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517385019",
      "ndc_label_name": "Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214085062",
      "ndc_label_name": "Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68016023400",
      "ndc_label_name": "Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470385001",
      "ndc_label_name": "Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68016030728",
      "ndc_label_name": "Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517383019",
      "ndc_label_name": "Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470383001",
      "ndc_label_name": "Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470183001",
      "ndc_label_name": "Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214083062",
      "ndc_label_name": "Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470284001",
      "ndc_label_name": "Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214084062",
      "ndc_label_name": "Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470384001",
      "ndc_label_name": "Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517384019",
      "ndc_label_name": "Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68016023700",
      "ndc_label_name": "Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470184001",
      "ndc_label_name": "Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470785501",
      "ndc_label_name": "Unifine PROtect Pen Needle 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470784501",
      "ndc_label_name": "Unifine PROtect Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470795501",
      "ndc_label_name": "Unifine SafeControl Pen Needle 30G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470795001",
      "ndc_label_name": "Unifine SafeControl Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470793001",
      "ndc_label_name": "Unifine SafeControl Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470794001",
      "ndc_label_name": "Unifine SafeControl Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517015015",
      "ndc_label_name": "Unifine Ultra Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470415001",
      "ndc_label_name": "Unifine Ultra Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517013015",
      "ndc_label_name": "Unifine Ultra Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470413001",
      "ndc_label_name": "Unifine Ultra Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470414001",
      "ndc_label_name": "Unifine Ultra Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08517014015",
      "ndc_label_name": "Unifine Ultra Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470043001",
      "ndc_label_name": "Unilet ComforTouch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214046501",
      "ndc_label_name": "Unilet ComforTouch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214046002",
      "ndc_label_name": "Unilet ComforTouch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470043501",
      "ndc_label_name": "Unilet ComforTouch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214046001",
      "ndc_label_name": "Unilet ComforTouch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470046501",
      "ndc_label_name": "Unilet ComforTouch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470046001",
      "ndc_label_name": "Unilet ComforTouch Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214051501",
      "ndc_label_name": "Unilet ExceLite",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470051001",
      "ndc_label_name": "Unilet ExceLite",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214051001",
      "ndc_label_name": "Unilet ExceLite",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470051501",
      "ndc_label_name": "Unilet ExceLite",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214053501",
      "ndc_label_name": "Unilet ExceLite II",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214053001",
      "ndc_label_name": "Unilet ExceLite II",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470053001",
      "ndc_label_name": "Unilet ExceLite II",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470053501",
      "ndc_label_name": "Unilet ExceLite II",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470041801",
      "ndc_label_name": "Unilet G.P. Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214041401",
      "ndc_label_name": "Unilet G.P. Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214041801",
      "ndc_label_name": "Unilet G.P. Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470041401",
      "ndc_label_name": "Unilet G.P. Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214045001",
      "ndc_label_name": "Unilet G.P. Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214045501",
      "ndc_label_name": "Unilet G.P. Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470045001",
      "ndc_label_name": "Unilet G.P. Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470045501",
      "ndc_label_name": "Unilet G.P. Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214092001",
      "ndc_label_name": "Unilet GP 28 Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470092001",
      "ndc_label_name": "Unilet GP 28 Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470092501",
      "ndc_label_name": "Unilet GP 28 Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214092501",
      "ndc_label_name": "Unilet GP 28 Ultra Thin",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517057536",
      "ndc_label_name": "Unilet Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517058536",
      "ndc_label_name": "Unilet Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214040001",
      "ndc_label_name": "Unilet Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470040001",
      "ndc_label_name": "Unilet Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68016073800",
      "ndc_label_name": "Unilet Micro-Thin 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470058501",
      "ndc_label_name": "Unilet Micro-Thin 33G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214057761",
      "ndc_label_name": "Unilet Super-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68016030554",
      "ndc_label_name": "Unilet Super-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470057501",
      "ndc_label_name": "Unilet Super-Thin 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214044501",
      "ndc_label_name": "Unilet Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214044001",
      "ndc_label_name": "Unilet Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470044001",
      "ndc_label_name": "Unilet Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470044501",
      "ndc_label_name": "Unilet Superlite Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470056501",
      "ndc_label_name": "Unilet Ultra-Thin 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214056761",
      "ndc_label_name": "Unilet Ultra-Thin 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08517056536",
      "ndc_label_name": "Unilet Ultra-Thin 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214060001",
      "ndc_label_name": "Unistik 1",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214061001",
      "ndc_label_name": "Unistik 1",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470061001",
      "ndc_label_name": "Unistik 1",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470060001",
      "ndc_label_name": "Unistik 1",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470074201",
      "ndc_label_name": "Unistik 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214070001",
      "ndc_label_name": "Unistik 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214070201",
      "ndc_label_name": "Unistik 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214074201",
      "ndc_label_name": "Unistik 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214076201",
      "ndc_label_name": "Unistik 2",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470074001",
      "ndc_label_name": "Unistik 2 Comfort",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470074701",
      "ndc_label_name": "Unistik 2 Comfort",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214071001",
      "ndc_label_name": "Unistik 2 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470071201",
      "ndc_label_name": "Unistik 2 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470071401",
      "ndc_label_name": "Unistik 2 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470071001",
      "ndc_label_name": "Unistik 2 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214071201",
      "ndc_label_name": "Unistik 2 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470076201",
      "ndc_label_name": "Unistik 2 Neonatal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470070401",
      "ndc_label_name": "Unistik 2 Normal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470070001",
      "ndc_label_name": "Unistik 2 Normal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470075201",
      "ndc_label_name": "Unistik 2 Super",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214075201",
      "ndc_label_name": "Unistik 2 Super",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214100201",
      "ndc_label_name": "Unistik 3",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214106201",
      "ndc_label_name": "Unistik 3",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08214104201",
      "ndc_label_name": "Unistik 3",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470104701",
      "ndc_label_name": "Unistik 3 Comfort",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470104201",
      "ndc_label_name": "Unistik 3 Comfort",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470104401",
      "ndc_label_name": "Unistik 3 Comfort",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470101801",
      "ndc_label_name": "Unistik 3 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470101201",
      "ndc_label_name": "Unistik 3 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470101401",
      "ndc_label_name": "Unistik 3 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470101701",
      "ndc_label_name": "Unistik 3 Extra",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470102201",
      "ndc_label_name": "Unistik 3 Gentle",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470102701",
      "ndc_label_name": "Unistik 3 Gentle",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470102401",
      "ndc_label_name": "Unistik 3 Gentle",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470102801",
      "ndc_label_name": "Unistik 3 Gentle",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470106201",
      "ndc_label_name": "Unistik 3 Neonatal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470106401",
      "ndc_label_name": "Unistik 3 Neonatal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470100201",
      "ndc_label_name": "Unistik 3 Normal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470100701",
      "ndc_label_name": "Unistik 3 Normal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470100401",
      "ndc_label_name": "Unistik 3 Normal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470104801",
      "ndc_label_name": "Unistik CZT Comfort",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470100801",
      "ndc_label_name": "Unistik CZT Normal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470070201",
      "ndc_label_name": "Unistik Normal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470161401",
      "ndc_label_name": "Unistik Pro Safety Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470164401",
      "ndc_label_name": "Unistik Pro Safety Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470163401",
      "ndc_label_name": "Unistik Pro Safety Lancet",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470144201",
      "ndc_label_name": "Unistik Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470142201",
      "ndc_label_name": "Unistik Safety Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470141401",
      "ndc_label_name": "Unistik Touch Safety Lanc 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470141201",
      "ndc_label_name": "Unistik Touch Safety Lanc 21G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470140201",
      "ndc_label_name": "Unistik Touch Safety Lanc 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470140401",
      "ndc_label_name": "Unistik Touch Safety Lanc 23G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470144401",
      "ndc_label_name": "Unistik Touch Safety Lanc 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08470142401",
      "ndc_label_name": "Unistik Touch Safety Lanc 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "89167037320",
      "ndc_label_name": "Unistrip Control SOLUTION High IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89167036210",
      "ndc_label_name": "Unistrip Control SOLUTION Low IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "89167024850",
      "ndc_label_name": "Unistrip1 Generic STRIP IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66302001401",
      "ndc_label_name": "Unituxin Solution 17.5 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83444030110",
      "ndc_label_name": "Unloxcyt Solution 300 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095013001",
      "ndc_label_name": "Unloxcyt Solution 300 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842012001",
      "ndc_label_name": "Vabomere Solution Reconstituted 2 (1-1) GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842012006",
      "ndc_label_name": "Vabomere Solution Reconstituted 2 (1-1) GM Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242009601",
      "ndc_label_name": "Vabysmo Solution 6 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242009606",
      "ndc_label_name": "Vabysmo Solution Prefilled Syringe 6 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24201010104",
      "ndc_label_name": "Valrubicin Solution 40 MG/ML Intravesical",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24201010101",
      "ndc_label_name": "Valrubicin Solution 40 MG/ML Intravesical",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67979000101",
      "ndc_label_name": "Valstar Solution 40 MG/ML Intravesical",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13703010210",
      "ndc_label_name": "VanishPoint Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13703010211",
      "ndc_label_name": "VanishPoint Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13703015221",
      "ndc_label_name": "VanishPoint Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13703015220",
      "ndc_label_name": "VanishPoint Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13703015270",
      "ndc_label_name": "VanishPoint Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13703015271",
      "ndc_label_name": "VanishPoint Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00006483101",
      "ndc_label_name": "Vaqta SUSPENSION 25 UNIT/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006483141",
      "ndc_label_name": "Vaqta SUSPENSION 25 UNIT/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006484101",
      "ndc_label_name": "Vaqta SUSPENSION 50 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006484141",
      "ndc_label_name": "Vaqta SUSPENSION 50 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006484100",
      "ndc_label_name": "Vaqta SUSPENSION 50 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409501",
      "ndc_label_name": "Vaqta Suspension Prefilled Syringe 25 UNIT/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409502",
      "ndc_label_name": "Vaqta Suspension Prefilled Syringe 25 UNIT/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409602",
      "ndc_label_name": "Vaqta Suspension Prefilled Syringe 50 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409601",
      "ndc_label_name": "Vaqta Suspension Prefilled Syringe 50 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006482701",
      "ndc_label_name": "Varivax Suspension Reconstituted 1350 PFU/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006482700",
      "ndc_label_name": "Varivax Suspension Reconstituted 1350 PFU/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591012651",
      "ndc_label_name": "Varizig Solution 125 UNIT/1.2ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257012611",
      "ndc_label_name": "Varizig Solution 125 UNIT/1.2ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591012611",
      "ndc_label_name": "Varizig Solution 125 UNIT/1.2ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257012651",
      "ndc_label_name": "Varizig Solution 125 UNIT/1.2ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090754200",
      "ndc_label_name": "Vaxelis Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63361024315",
      "ndc_label_name": "Vaxelis Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63361024388",
      "ndc_label_name": "Vaxelis Suspension Prefilled Syringe Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006432903",
      "ndc_label_name": "Vaxneuvance Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006432902",
      "ndc_label_name": "Vaxneuvance Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52925011201",
      "ndc_label_name": "VCF Vaginal Contraceptive FILM 28 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52925051210",
      "ndc_label_name": "VCF Vaginal Contraceptive Gel 4 % Vaginal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "55513095401",
      "ndc_label_name": "Vectibix Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513095421",
      "ndc_label_name": "Vectibix Solution 100 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513095621",
      "ndc_label_name": "Vectibix Solution 400 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513095601",
      "ndc_label_name": "Vectibix Solution 400 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143923401",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703291403",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703291401",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093140",
      "ndc_label_name": "Vecuronium Bromide SOLUTION RECONSTITUTED 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323078144",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143923410",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457043800",
      "ndc_label_name": "Vecuronium Bromide SOLUTION RECONSTITUTED 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163201",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163221",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457043810",
      "ndc_label_name": "Vecuronium Bromide SOLUTION RECONSTITUTED 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323078110",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023510",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81565020601",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068510",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323078141",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323078121",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093144",
      "ndc_label_name": "Vecuronium Bromide SOLUTION RECONSTITUTED 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023501",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301005601",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288074411",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023502",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288074410",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023511",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81565020602",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301005602",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143923210",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023601",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023602",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093244",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143923201",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093240",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068620",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457047500",
      "ndc_label_name": "Vecuronium Bromide SOLUTION RECONSTITUTED 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023620",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288074521",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023621",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301005701",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457047520",
      "ndc_label_name": "Vecuronium Bromide SOLUTION RECONSTITUTED 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301005702",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323078220",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288074520",
      "ndc_label_name": "Vecuronium Bromide Solution Reconstituted 20 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606001101",
      "ndc_label_name": "Vegzelma Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606001201",
      "ndc_label_name": "Vegzelma Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020004904",
      "ndc_label_name": "Velcade Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020004901",
      "ndc_label_name": "Velcade Solution Reconstituted 3.5 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66215040301",
      "ndc_label_name": "Veletri Solution Reconstituted 0.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66215040201",
      "ndc_label_name": "Veletri Solution Reconstituted 1.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57513000610",
      "ndc_label_name": "Verasens Blood Glucose Test STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000611",
      "ndc_label_name": "Verasens Blood Glucose Test STRIP In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57513000614",
      "ndc_label_name": "Verasens Glucose Control Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083342",
      "ndc_label_name": "Verifine Insulin Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083343",
      "ndc_label_name": "Verifine Insulin Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083304",
      "ndc_label_name": "Verifine Insulin Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083326",
      "ndc_label_name": "Verifine Insulin Pen Needle 32G X 6 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50062021823",
      "ndc_label_name": "Verifine Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083376",
      "ndc_label_name": "Verifine Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083385",
      "ndc_label_name": "Verifine Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083358",
      "ndc_label_name": "Verifine Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083378",
      "ndc_label_name": "Verifine Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083390",
      "ndc_label_name": "Verifine Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083388",
      "ndc_label_name": "Verifine Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083375",
      "ndc_label_name": "Verifine Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083355",
      "ndc_label_name": "Verifine Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083357",
      "ndc_label_name": "Verifine Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083377",
      "ndc_label_name": "Verifine Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083379",
      "ndc_label_name": "Verifine Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083384",
      "ndc_label_name": "Verifine Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083366",
      "ndc_label_name": "Verifine Plus Pen Needle 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083368",
      "ndc_label_name": "Verifine Plus Pen Needle 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083369",
      "ndc_label_name": "Verifine Plus Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083386",
      "ndc_label_name": "Verifine Plus Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083387",
      "ndc_label_name": "Verifine Plus Pen Needle 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50011083323",
      "ndc_label_name": "Verifine Safe Lancet Mini 21G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083333",
      "ndc_label_name": "Verifine Safe Lancet Mini 23G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083312",
      "ndc_label_name": "Verifine Safe Lancet Mini 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083313",
      "ndc_label_name": "Verifine Safe Lancet Mini 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083360",
      "ndc_label_name": "Verifine Universal Lancets 28G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083350",
      "ndc_label_name": "Verifine Universal Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50011083344",
      "ndc_label_name": "Verifine Universal Lancets 33G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351068510",
      "ndc_label_name": "VersaPAP Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351068310",
      "ndc_label_name": "VersaPAP w/Universal Tubing Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59572010201",
      "ndc_label_name": "Vidaza SUSPENSION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323027810",
      "ndc_label_name": "VinBLAStine Sulfate SOLUTION 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030925",
      "ndc_label_name": "vinCRIStine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030926",
      "ndc_label_name": "vinCRIStine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030906",
      "ndc_label_name": "vinCRIStine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61703030916",
      "ndc_label_name": "vinCRIStine Sulfate Solution 2 MG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323014801",
      "ndc_label_name": "Vinorelbine Tartrate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020401",
      "ndc_label_name": "Vinorelbine Tartrate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963060755",
      "ndc_label_name": "Vinorelbine Tartrate SOLUTION 10 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323014805",
      "ndc_label_name": "Vinorelbine Tartrate SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963060756",
      "ndc_label_name": "Vinorelbine Tartrate SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021020405",
      "ndc_label_name": "Vinorelbine Tartrate SOLUTION 50 MG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222216",
      "ndc_label_name": "Visipaque Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222217",
      "ndc_label_name": "Visipaque Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222219",
      "ndc_label_name": "Visipaque Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222221",
      "ndc_label_name": "Visipaque Solution 270 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222364",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222316",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222319",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222317",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222366",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222321",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222323",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222362",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00407222367",
      "ndc_label_name": "Visipaque Solution 320 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953002008",
      "ndc_label_name": "Vistaseal Prefilled Syringe Kit 10 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953001401",
      "ndc_label_name": "Vistaseal Prefilled Syringe Kit 10 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953002007",
      "ndc_label_name": "Vistaseal Prefilled Syringe Kit 10 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953001101",
      "ndc_label_name": "Vistaseal Prefilled Syringe Kit 2 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953001201",
      "ndc_label_name": "Vistaseal Prefilled Syringe Kit 4 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953002004",
      "ndc_label_name": "Vistaseal Prefilled Syringe Kit 4 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61953002003",
      "ndc_label_name": "Vistaseal Prefilled Syringe Kit 4 ML External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208056015",
      "ndc_label_name": "Visudyne Solution Reconstituted 15 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187560015",
      "ndc_label_name": "Visudyne Solution Reconstituted 15 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409915701",
      "ndc_label_name": "Vitamin K1 SOLUTION 1 MG/0.5ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409915731",
      "ndc_label_name": "Vitamin K1 Solution 1 MG/0.5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409915811",
      "ndc_label_name": "Vitamin K1 Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409915825",
      "ndc_label_name": "Vitamin K1 Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409915801",
      "ndc_label_name": "Vitamin K1 Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409915831",
      "ndc_label_name": "Vitamin K1 Solution 10 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40423050004",
      "ndc_label_name": "VivaGuard Ino Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40423050003",
      "ndc_label_name": "VivaGuard Ino Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40423050034",
      "ndc_label_name": "VivaGuard Ino Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53483000807",
      "ndc_label_name": "VivaGuard Ino Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53483000817",
      "ndc_label_name": "VivaGuard Ino Control Solution Liquid In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53483000818",
      "ndc_label_name": "VivaGuard Ino Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53483000801",
      "ndc_label_name": "VivaGuard Ino Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40423050002",
      "ndc_label_name": "VivaGuard Ino Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40423050001",
      "ndc_label_name": "VivaGuard Ino Test Strips Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53483000813",
      "ndc_label_name": "VivaGuard Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53483000814",
      "ndc_label_name": "VivaGuard Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40423050011",
      "ndc_label_name": "VivaGuard Lancets 30G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40423050013",
      "ndc_label_name": "VivaGuard Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53483000803",
      "ndc_label_name": "VivaGuard Lancing Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40423050018",
      "ndc_label_name": "VivaGuard Safety Lancets 28G",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71225012001",
      "ndc_label_name": "Vivimusta Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338027001",
      "ndc_label_name": "Vivimusta Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156006730",
      "ndc_label_name": "Vizamyl SOLUTION 4.05 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156006701",
      "ndc_label_name": "Vizamyl SOLUTION 4.05 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50633021011",
      "ndc_label_name": "Voraxaze SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44229051049",
      "ndc_label_name": "Vortex Valve Chamber-Pedi Mask Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "44229051048",
      "ndc_label_name": "Vortex Valved Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "44229051058",
      "ndc_label_name": "Vortex Valved Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "44229051047",
      "ndc_label_name": "Vortex Valved Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490051035",
      "ndc_label_name": "Vortex Valved Holding Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83831014835",
      "ndc_label_name": "Vykoura Solution 350 MG/35ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831014705",
      "ndc_label_name": "Vykoura Solution 50 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83831014950",
      "ndc_label_name": "Vykoura Solution 500 MG/50ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469342510",
      "ndc_label_name": "Vyloy Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469442530",
      "ndc_label_name": "Vyloy Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727074502",
      "ndc_label_name": "Vyxeos Suspension Reconstituted 44-100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727074501",
      "ndc_label_name": "Vyxeos Suspension Reconstituted 44-100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080503300",
      "ndc_label_name": "Webcol Alcohol Prep Large PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "84527002060",
      "ndc_label_name": "Webcol Alcohol Prep Large Pad 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080511000",
      "ndc_label_name": "Webcol Alcohol Prep Large PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080681800",
      "ndc_label_name": "Webcol Alcohol Prep Medium PAD 70 %",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214085054",
      "ndc_label_name": "Wegmans Unifine Pentips Plus 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214083054",
      "ndc_label_name": "Wegmans Unifine Pentips Plus 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214084054",
      "ndc_label_name": "Wegmans Unifine Pentips Plus 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00396401060",
      "ndc_label_name": "Wide-Seal Diaphragm 60 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396401065",
      "ndc_label_name": "Wide-Seal Diaphragm 65 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396401070",
      "ndc_label_name": "Wide-Seal Diaphragm 70 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396401075",
      "ndc_label_name": "Wide-Seal Diaphragm 75 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396401080",
      "ndc_label_name": "Wide-Seal Diaphragm 80 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396401085",
      "ndc_label_name": "Wide-Seal Diaphragm 85 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396401090",
      "ndc_label_name": "Wide-Seal Diaphragm 90 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00396401095",
      "ndc_label_name": "Wide-Seal Diaphragm 95 DIAPHRAGM 2 % VAGINAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462122015",
      "ndc_label_name": "Windmill Trainer",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49591033051",
      "ndc_label_name": "WinRho SDF Solution 1500 UNIT/1.3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49591033011",
      "ndc_label_name": "WinRho SDF Solution 1500 UNIT/1.3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257033051",
      "ndc_label_name": "WinRho SDF Solution 1500 UNIT/1.3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70257033011",
      "ndc_label_name": "WinRho SDF Solution 1500 UNIT/1.3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11701016116",
      "ndc_label_name": "Woun'Dres Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63921042003",
      "ndc_label_name": "Wound Gel Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63921045008",
      "ndc_label_name": "Wound Gel Spray Gel External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13533081006",
      "ndc_label_name": "Xembify Solution 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533081005",
      "ndc_label_name": "Xembify Solution 1 GM/5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533081050",
      "ndc_label_name": "Xembify Solution 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533081051",
      "ndc_label_name": "Xembify Solution 10 GM/50ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533081011",
      "ndc_label_name": "Xembify Solution 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533081010",
      "ndc_label_name": "Xembify Solution 2 GM/10ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533081020",
      "ndc_label_name": "Xembify Solution 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533081021",
      "ndc_label_name": "Xembify Solution 4 GM/20ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994012715",
      "ndc_label_name": "Xenon Xe 133 GAS 10 MCI Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994012711",
      "ndc_label_name": "Xenon Xe 133 GAS 10 MCI Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994012821",
      "ndc_label_name": "Xenon Xe 133 Gas 20 MCI Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11994012825",
      "ndc_label_name": "Xenon Xe 133 Gas 20 MCI Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00259411001",
      "ndc_label_name": "Xeomin Solution Reconstituted 100 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00259161001",
      "ndc_label_name": "Xeomin SOLUTION RECONSTITUTED 100 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00259162001",
      "ndc_label_name": "Xeomin SOLUTION RECONSTITUTED 200 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00259415001",
      "ndc_label_name": "Xeomin Solution Reconstituted 50 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00259160501",
      "ndc_label_name": "Xeomin SOLUTION RECONSTITUTED 50 UNIT Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71565004025",
      "ndc_label_name": "Xipere Suspension 40 MG/ML Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208004040",
      "ndc_label_name": "Xipere Suspension 40 MG/ML Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71565004001",
      "ndc_label_name": "Xipere Suspension 40 MG/ML Intraocular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419020801",
      "ndc_label_name": "Xofigo SOLUTION 30 MCCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219081002",
      "ndc_label_name": "Xylocaine MPF +RFID Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219081001",
      "ndc_label_name": "Xylocaine MPF +RFID Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048457",
      "ndc_label_name": "Xylocaine SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048501",
      "ndc_label_name": "Xylocaine Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048527",
      "ndc_label_name": "Xylocaine SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048503",
      "ndc_label_name": "Xylocaine Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048541",
      "ndc_label_name": "Xylocaine Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048526",
      "ndc_label_name": "Xylocaine SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048557",
      "ndc_label_name": "Xylocaine SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048605",
      "ndc_label_name": "Xylocaine Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048602",
      "ndc_label_name": "Xylocaine Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048641",
      "ndc_label_name": "Xylocaine Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048601",
      "ndc_label_name": "Xylocaine Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048626",
      "ndc_label_name": "Xylocaine SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048657",
      "ndc_label_name": "Xylocaine SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048617",
      "ndc_label_name": "Xylocaine SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048627",
      "ndc_label_name": "Xylocaine SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219081405",
      "ndc_label_name": "Xylocaine-MPF +RFID Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219081401",
      "ndc_label_name": "Xylocaine-MPF +RFID Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219081201",
      "ndc_label_name": "Xylocaine-MPF +RFID Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219081202",
      "ndc_label_name": "Xylocaine-MPF +RFID Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049101",
      "ndc_label_name": "Xylocaine-MPF Solution 0.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049157",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 0.5 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049204",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049208",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049216",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049243",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049231",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049227",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049203",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049209",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049207",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049237",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049236",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049226",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049241",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049297",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049245",
      "ndc_label_name": "Xylocaine-MPF Solution 1 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049257",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049303",
      "ndc_label_name": "Xylocaine-MPF Solution 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049301",
      "ndc_label_name": "Xylocaine-MPF Solution 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049391",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049397",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 1.5 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049507",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049541",
      "ndc_label_name": "Xylocaine-MPF Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049526",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049504",
      "ndc_label_name": "Xylocaine-MPF Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049697",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 2 % INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049603",
      "ndc_label_name": "Xylocaine-MPF Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049509",
      "ndc_label_name": "Xylocaine-MPF Solution 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323049527",
      "ndc_label_name": "Xylocaine-MPF SOLUTION 2 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048717",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048703",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048731",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048707",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048701",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048737",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048831",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048817",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048803",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048889",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048801",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048807",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048837",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 1.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048901",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048902",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048927",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090332101",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048917",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048903",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048921",
      "ndc_label_name": "Xylocaine-MPF/EPINEPHrine Solution 2 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048101",
      "ndc_label_name": "Xylocaine/EPINEPHrine Solution 0.5 %-1:200000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048157",
      "ndc_label_name": "Xylocaine/Epinephrine SOLUTION 0.5 %-1:200000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048226",
      "ndc_label_name": "Xylocaine/Epinephrine SOLUTION 1 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048203",
      "ndc_label_name": "Xylocaine/Epinephrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048201",
      "ndc_label_name": "Xylocaine/Epinephrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048205",
      "ndc_label_name": "Xylocaine/Epinephrine Solution 1 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048227",
      "ndc_label_name": "Xylocaine/Epinephrine SOLUTION 1 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048217",
      "ndc_label_name": "Xylocaine/Epinephrine SOLUTION 1 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048257",
      "ndc_label_name": "Xylocaine/Epinephrine SOLUTION 1 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048303",
      "ndc_label_name": "Xylocaine/Epinephrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048301",
      "ndc_label_name": "Xylocaine/Epinephrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090685100",
      "ndc_label_name": "Xylocaine/EPINEPHrine Solution 2 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048357",
      "ndc_label_name": "Xylocaine/Epinephrine SOLUTION 2 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323048327",
      "ndc_label_name": "Xylocaine/Epinephrine SOLUTION 2 %-1:100000 INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003232822",
      "ndc_label_name": "Yervoy Solution 200 MG/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003232711",
      "ndc_label_name": "Yervoy Solution 50 MG/10ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257003541",
      "ndc_label_name": "Yesafili Solution Prefilled Syringe 2 MG/0.05ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676061001",
      "ndc_label_name": "Yondelis SOLUTION RECONSTITUTED 1 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024584001",
      "ndc_label_name": "Zaltrap SOLUTION 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024584101",
      "ndc_label_name": "Zaltrap SOLUTION 200 MG/8ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "89116000020",
      "ndc_label_name": "Zanabin Hydrogel GEL EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727071201",
      "ndc_label_name": "Zepzelca Solution Reconstituted 4 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50632000773",
      "ndc_label_name": "ZevRx Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000772",
      "ndc_label_name": "ZevRx Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000782",
      "ndc_label_name": "ZevRx Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000777",
      "ndc_label_name": "ZevRx Pen Needles 31G X 5 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000779",
      "ndc_label_name": "ZevRx Pen Needles 31G X 8 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000780",
      "ndc_label_name": "ZevRx Pen Needles 32G X 4 MM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000775",
      "ndc_label_name": "ZevRx Sterile Alcohol Prep Pad Pad 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50632000776",
      "ndc_label_name": "ZevRx Twist Top Lancets 30G",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68727095002",
      "ndc_label_name": "Ziihera Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68727095001",
      "ndc_label_name": "Ziihera Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006302500",
      "ndc_label_name": "Zinplava SOLUTION 1000 MG/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006302501",
      "ndc_label_name": "Zinplava Solution 1000 MG/40ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069031501",
      "ndc_label_name": "Zirabev Solution 100 MG/4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069034201",
      "ndc_label_name": "Zirabev Solution 400 MG/16ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72493010603",
      "ndc_label_name": "Zusduri Kit 2 x 40 MG Intravesical",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79952011001",
      "ndc_label_name": "Zynlonta Solution Reconstituted 10 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47426030305",
      "ndc_label_name": "Zynrelef Solution 200-6 MG/7ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47426050301",
      "ndc_label_name": "Zynrelef Solution 200-6 MG/7ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47426030301",
      "ndc_label_name": "Zynrelef Solution 200-6 MG/7ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47426030102",
      "ndc_label_name": "Zynrelef Solution 400-12 MG/14ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47426030106",
      "ndc_label_name": "Zynrelef Solution 400-12 MG/14ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47426050106",
      "ndc_label_name": "Zynrelef Solution 400-12 MG/14ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47426050102",
      "ndc_label_name": "Zynrelef Solution 400-12 MG/14ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50881000603",
      "ndc_label_name": "Zynyz Solution 500 MG/20ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021084110",
      "ndc_label_name": "Zyogreen Solution 25 MG/10ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    }
  ]
}